Provider Demographics
NPI:1114453412
Name:NOEL, ALEXIS (PTA)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:NOEL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7328 BOLTON WAY
Mailing Address - Street 2:
Mailing Address - City:INVER GROVE HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55076-2350
Mailing Address - Country:US
Mailing Address - Phone:651-399-3514
Mailing Address - Fax:
Practice Address - Street 1:56299 29 PALMS HWY
Practice Address - Street 2:
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-2857
Practice Address - Country:US
Practice Address - Phone:760-369-1743
Practice Address - Fax:760-365-6934
Is Sole Proprietor?:No
Enumeration Date:2017-05-04
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48259225200000X
AZPTA-011958225200000X
TX2118810225200000X
MNA1945225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant