Provider Demographics
NPI:1881065886
Name:EITAN, NOAM (PT)
Entity type:Individual
Prefix:
First Name:NOAM
Middle Name:
Last Name:EITAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:654 BEACON ST
Mailing Address - Street 2:STE 2
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-2099
Mailing Address - Country:US
Mailing Address - Phone:617-536-1161
Mailing Address - Fax:617-536-1165
Practice Address - Street 1:1838 GREENE TREE RD
Practice Address - Street 2:STE 290
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-6391
Practice Address - Country:US
Practice Address - Phone:410-653-9813
Practice Address - Fax:410-653-9815
Is Sole Proprietor?:No
Enumeration Date:2015-10-15
Last Update Date:2017-11-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MD25625225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist