Provider Demographics
NPI:1104186980
Name:NOBLETT, KASIA P (DPT)
Entity Type:Individual
Prefix:
First Name:KASIA
Middle Name:P
Last Name:NOBLETT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4920 WOODMAR DR SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-1651
Mailing Address - Country:US
Mailing Address - Phone:540-400-0897
Mailing Address - Fax:540-400-0904
Practice Address - Street 1:4920 WOODMAR DR SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-1651
Practice Address - Country:US
Practice Address - Phone:540-400-0897
Practice Address - Fax:540-400-0904
Is Sole Proprietor?:No
Enumeration Date:2012-05-25
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305006566225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAQ54254AMedicare PIN
VAP01713097Medicare UPIN