Provider Demographics
NPI:1457461360
Name:MIKE NOONAN PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:MIKE NOONAN PHYSICAL THERAPY, LLC
Other - Org Name:NOONAN PHYSICAL THERAPY & ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PT, DPT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:NOONAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-885-4636
Mailing Address - Street 1:5956 E PIMA ST
Mailing Address - Street 2:STE 100
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-4375
Mailing Address - Country:US
Mailing Address - Phone:520-885-4636
Mailing Address - Fax:520-885-4736
Practice Address - Street 1:5956 E PIMA ST
Practice Address - Street 2:STE 100
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-4375
Practice Address - Country:US
Practice Address - Phone:520-885-4636
Practice Address - Fax:520-885-4736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1786225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ416705Medicaid
AZ6679240001Medicare NSC
AZ416705Medicaid