Provider Demographics
NPI:1225755382
Name:JANSSEN, NOAH (PT, DPT)
Entity Type:Individual
Prefix:
First Name:NOAH
Middle Name:
Last Name:JANSSEN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1612 N IZABEL ST
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-4912
Mailing Address - Country:US
Mailing Address - Phone:815-520-9089
Mailing Address - Fax:
Practice Address - Street 1:2151 S HIGHWAY 92 STE 106
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-5283
Practice Address - Country:US
Practice Address - Phone:520-335-1615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-32174225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist