Provider Demographics
NPI:1124408828
Name:NOONAN PHYSICAL THERAPY & ASSOCIATES NORTHWEST, LLC
Entity Type:Organization
Organization Name:NOONAN PHYSICAL THERAPY & ASSOCIATES NORTHWEST, LLC
Other - Org Name:NOONAN PHYSICAL THERAPY & ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:NOONAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:520-574-0200
Mailing Address - Street 1:5880 N LA CHOLLA BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-3593
Mailing Address - Country:US
Mailing Address - Phone:520-639-8122
Mailing Address - Fax:520-639-8124
Practice Address - Street 1:5880 N LA CHOLLA BLVD
Practice Address - Street 2:SUITE120
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-3593
Practice Address - Country:US
Practice Address - Phone:520-574-0200
Practice Address - Fax:520-639-8124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-08
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ027293Medicaid
AZZ177834Medicare PIN