Provider Demographics
NPI:1376844647
Name:NOONAN, DANIEL TREVOR (MT)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:TREVOR
Last Name:NOONAN
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1517 CRAWFORD WAY
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601-4577
Mailing Address - Country:US
Mailing Address - Phone:970-309-8721
Mailing Address - Fax:
Practice Address - Street 1:1517 CRAWFORD WAY
Practice Address - Street 2:
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-4577
Practice Address - Country:US
Practice Address - Phone:970-309-8721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9399171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO969209OtherASSOCIATED BODYWORK & MASSAGE PROFESSIONALS