Provider Demographics
NPI:1689681199
Name:MADRASO, NOELLE NATALE (PT)
Entity Type:Individual
Prefix:
First Name:NOELLE
Middle Name:NATALE
Last Name:MADRASO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:NOELLE
Other - Middle Name:MARIE
Other - Last Name:NATALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 33296
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89533-3296
Mailing Address - Country:US
Mailing Address - Phone:775-440-3706
Mailing Address - Fax:775-204-9774
Practice Address - Street 1:10200 TIMBERWOLF DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89523-9664
Practice Address - Country:US
Practice Address - Phone:775-440-3206
Practice Address - Fax:775-204-9774
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2958225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV6617247OtherAETNA