Provider Demographics
NPI:1740372283
Name:NOLL, ADELE (PT)
Entity type:Individual
Prefix:
First Name:ADELE
Middle Name:
Last Name:NOLL
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 1:1750 30TH ST # 187
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1029
Mailing Address - Country:US
Mailing Address - Phone:303-494-1959
Mailing Address - Fax:
Practice Address - Street 1:1750 30TH ST # 187
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1029
Practice Address - Country:US
Practice Address - Phone:303-494-1959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3926225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO802600Medicare ID - Type Unspecified