Provider Demographics
NPI:1285842591
Name:NOEL, ERICA RENEE (PT)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:RENEE
Last Name:NOEL
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 1:1502 E KEIM DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-1752
Mailing Address - Country:US
Mailing Address - Phone:908-578-4820
Mailing Address - Fax:
Practice Address - Street 1:4840 E INDIAN SCHOOL RD
Practice Address - Street 2:SUITE 103
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-5500
Practice Address - Country:US
Practice Address - Phone:602-956-2850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2008-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA01081000225100000X
AZ6668225100000X
CO8873225100000X
CA30296225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist