Provider Demographics
NPI:1467557827
Name:NOYES, KIM (PT)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:NOYES
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 1:38 CR 5285
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NM
Mailing Address - Zip Code:87413
Mailing Address - Country:US
Mailing Address - Phone:505-632-3477
Mailing Address - Fax:
Practice Address - Street 1:3180 N. BUTLER AVE.
Practice Address - Street 2:BLDG. 300
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401
Practice Address - Country:US
Practice Address - Phone:505-326-2460
Practice Address - Fax:505-325-1943
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1146225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist