Provider Demographics
NPI:1609433200
Name:PUWOL, NOELLA
Entity Type:Individual
Prefix:
First Name:NOELLA
Middle Name:
Last Name:PUWOL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2530 CITRUS TOWER BLVD APT 17103
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-6920
Mailing Address - Country:US
Mailing Address - Phone:954-661-3522
Mailing Address - Fax:
Practice Address - Street 1:15745 DORA AVE STE B
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-4943
Practice Address - Country:US
Practice Address - Phone:352-357-8358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-20
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL34600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist