Provider Demographics
NPI:1477792786
Name:PADILLA, NOEL B (NOEL PADILLA)
Entity Type:Individual
Prefix:MR
First Name:NOEL
Middle Name:B
Last Name:PADILLA
Suffix:
Gender:M
Credentials:NOEL PADILLA
Other - Prefix:
Other - First Name:NOEL
Other - Middle Name:
Other - Last Name:PADILLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:10130 ASHWOOD PL
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-1357
Mailing Address - Country:US
Mailing Address - Phone:561-736-0948
Mailing Address - Fax:561-736-0948
Practice Address - Street 1:10130 ASHWOOD PL
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-1357
Practice Address - Country:US
Practice Address - Phone:561-736-0948
Practice Address - Fax:561-736-0948
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-10
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA48147225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist