Provider Demographics
NPI:1740611490
Name:MCGILVRAY, NOELLE
Entity Type:Individual
Prefix:
First Name:NOELLE
Middle Name:
Last Name:MCGILVRAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NOLLE
Other - Middle Name:
Other - Last Name:GERLAC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5601 OKEECHOBEE BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33417-4489
Mailing Address - Country:US
Mailing Address - Phone:561-202-6488
Mailing Address - Fax:561-202-6486
Practice Address - Street 1:5601 OKEECHOBEE BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33417-4489
Practice Address - Country:US
Practice Address - Phone:561-202-6488
Practice Address - Fax:561-202-6486
Is Sole Proprietor?:No
Enumeration Date:2013-12-06
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT287822251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic