Provider Demographics
NPI:1477641603
Name:NOEL, GREG S (PT)
Entity Type:Individual
Prefix:DR
First Name:GREG
Middle Name:S
Last Name:NOEL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3850 E LOHMAN AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8273
Mailing Address - Country:US
Mailing Address - Phone:575-521-0793
Mailing Address - Fax:575-532-1607
Practice Address - Street 1:3850 E LOHMAN AVE STE 100
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8273
Practice Address - Country:US
Practice Address - Phone:575-521-0793
Practice Address - Fax:575-532-1607
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1423225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00074926Medicaid
S70703Medicare UPIN
348703701Medicare PIN