Provider Demographics
NPI:1114101250
Name:NOONAN, MICHAEL EDWARD (CAR, LMP)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:EDWARD
Last Name:NOONAN
Suffix:
Gender:M
Credentials:CAR, LMP
Other - Prefix:MR
Other - First Name:MISHA
Other - Middle Name:
Other - Last Name:NOONAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CAR, LMP
Mailing Address - Street 1:17220 127TH PL. NE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072
Mailing Address - Country:US
Mailing Address - Phone:425-424-9349
Mailing Address - Fax:425-424-9349
Practice Address - Street 1:17220 127TH PL NE
Practice Address - Street 2:SUITE 101
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-7965
Practice Address - Country:US
Practice Address - Phone:425-424-9349
Practice Address - Fax:425-424-9349
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-26
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWA0003524172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist