Provider Demographics
NPI:1841377140
Name:NOEL PHYSICAL THERAPY & SPORTS MEDICINE INC
Entity type:Organization
Organization Name:NOEL PHYSICAL THERAPY & SPORTS MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:NOEL
Authorized Official - Suffix:
Authorized Official - Credentials:PT MS SCS
Authorized Official - Phone:870-698-9300
Mailing Address - Street 1:920 HARRISON STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501
Mailing Address - Country:US
Mailing Address - Phone:870-698-9300
Mailing Address - Fax:870-698-9307
Practice Address - Street 1:920 HARRISON STREET
Practice Address - Street 2:SUITE B
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501
Practice Address - Country:US
Practice Address - Phone:870-698-9300
Practice Address - Fax:870-698-9307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT1461225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5C980Medicare PIN