Provider Demographics
NPI:1902415607
Name:NOBLE, MARK ALFRED (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ALFRED
Last Name:NOBLE
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17233 N HOLMES BLVD STE 1650
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-2031
Mailing Address - Country:US
Mailing Address - Phone:602-547-1836
Mailing Address - Fax:
Practice Address - Street 1:17233 N HOLMES BLVD STE 1650
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-2031
Practice Address - Country:US
Practice Address - Phone:602-547-1836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-28
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-31415225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLPT-31415OtherARIZONA STATE BOARD OF PHYSICAL THERAPY