Provider Demographics
NPI:1508934795
Name:NOAH, ANTHONY SCOTT (PT)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:SCOTT
Last Name:NOAH
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 1:6098 CHULA VISTA RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHSIDE
Mailing Address - State:AL
Mailing Address - Zip Code:35907-5646
Mailing Address - Country:US
Mailing Address - Phone:256-442-6623
Mailing Address - Fax:256-494-4667
Practice Address - Street 1:1007 GOODYEAR AVE
Practice Address - Street 2:DEPT. OF REHABILITATION
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35903-1195
Practice Address - Country:US
Practice Address - Phone:256-494-4163
Practice Address - Fax:256-494-4667
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH2199225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51092489OtherBLUE CROSS
AL51092489OtherBLUE CROSS
ALAL0709Medicare UPIN