Provider Demographics
NPI:1134754039
Name:NOBLE, TINA LYNN (MPT)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:LYNN
Last Name:NOBLE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:LYNN
Other - Last Name:KREMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:217 E BREMER AVE
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:IA
Mailing Address - Zip Code:50677-3435
Mailing Address - Country:US
Mailing Address - Phone:319-352-4544
Mailing Address - Fax:319-352-4655
Practice Address - Street 1:217 E BREMER AVE
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:IA
Practice Address - Zip Code:50677-3435
Practice Address - Country:US
Practice Address - Phone:319-352-4544
Practice Address - Fax:319-352-4655
Is Sole Proprietor?:No
Enumeration Date:2020-03-11
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.012490225100000X
IA03241225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist