Provider Demographics
NPI:1457599011
Name:PHILLIPS, NOELLE (PT)
Entity Type:Individual
Prefix:
First Name:NOELLE
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1917 NEWFOUND HARBOR DR
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-2844
Mailing Address - Country:US
Mailing Address - Phone:407-227-7781
Mailing Address - Fax:321-456-9906
Practice Address - Street 1:5650 S WASHINGTON AVE
Practice Address - Street 2:PARRISH PEDIATRIC REHAB
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780-7312
Practice Address - Country:US
Practice Address - Phone:321-360-9288
Practice Address - Fax:321-456-9906
Is Sole Proprietor?:No
Enumeration Date:2009-02-04
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT24252225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist