Provider Demographics
NPI:1790767630
Name:NOEL, GREGORY SCOTT (PT MS SCS)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:SCOTT
Last Name:NOEL
Suffix:
Gender:M
Credentials:PT MS SCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10351 BARKLEY ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-1876
Mailing Address - Country:US
Mailing Address - Phone:913-385-0564
Mailing Address - Fax:913-385-0562
Practice Address - Street 1:10351 BARKLEY ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-1876
Practice Address - Country:US
Practice Address - Phone:913-385-0564
Practice Address - Fax:913-385-0562
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT1461225100000X
KS11-03920225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR138854721Medicaid
KSKA2463004Medicare PIN
AR5X514Medicare ID - Type Unspecified
KSKA2202001Medicare PIN
KSKA2202Medicare PIN
KSKA2463Medicare PIN