Provider Demographics
NPI:1457519555
Name:BAUTISTA, NOEL P (PT)
Entity Type:Individual
Prefix:MR
First Name:NOEL
Middle Name:P
Last Name:BAUTISTA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34434 KING STREET ROW
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-4787
Mailing Address - Country:US
Mailing Address - Phone:302-645-0312
Mailing Address - Fax:302-645-0342
Practice Address - Street 1:34434 KING STREET ROW
Practice Address - Street 2:SUITE 1
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-4787
Practice Address - Country:US
Practice Address - Phone:302-645-0312
Practice Address - Fax:302-645-0342
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0000878225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist