Provider Demographics
NPI:1740022011
Name:ELEY, NOAH WILLIAM (PT, DPT)
Entity type:Individual
Prefix:
First Name:NOAH
Middle Name:WILLIAM
Last Name:ELEY
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 1:4501 MARVEL LN
Mailing Address - Street 2:
Mailing Address - City:EMMETT
Mailing Address - State:ID
Mailing Address - Zip Code:83617-9043
Mailing Address - Country:US
Mailing Address - Phone:714-486-5654
Mailing Address - Fax:
Practice Address - Street 1:4623 ENTERPRISE WAY
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-6764
Practice Address - Country:US
Practice Address - Phone:208-455-4231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-08
Last Update Date:2024-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT303210225100000X
IDPT-9161225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist