Provider Demographics
NPI:1710931944
Name:NOONAN PHYSICAL THERAPY, PC
Entity Type:Organization
Organization Name:NOONAN PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:NOONAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:802-253-5694
Mailing Address - Street 1:4968 MOUNTAIN RD
Mailing Address - Street 2:PO BOX 3421
Mailing Address - City:STOWE
Mailing Address - State:VT
Mailing Address - Zip Code:05672-4885
Mailing Address - Country:US
Mailing Address - Phone:802-253-5694
Mailing Address - Fax:
Practice Address - Street 1:4968 MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:STOWE
Practice Address - State:VT
Practice Address - Zip Code:05672-4885
Practice Address - Country:US
Practice Address - Phone:802-253-5694
Practice Address - Fax:802-253-5697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0VN3447Medicaid
VTVN3553Medicare ID - Type Unspecified