Provider Demographics
NPI:1245243658
Name:NOE, DIANE K (PT)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:K
Last Name:NOE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N5596 DAGO SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:SPOONER
Mailing Address - State:WI
Mailing Address - Zip Code:54801-8482
Mailing Address - Country:US
Mailing Address - Phone:715-635-6309
Mailing Address - Fax:
Practice Address - Street 1:N5596 DAGO SPRINGS DR
Practice Address - Street 2:
Practice Address - City:SPOONER
Practice Address - State:WI
Practice Address - Zip Code:54801-8482
Practice Address - Country:US
Practice Address - Phone:715-635-6309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2181225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40364200Medicaid