Provider Demographics
NPI:1881122307
Name:NOLL, REBECCA (LMT)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:NOLL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33215 COVENTRY DR
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34788-3614
Mailing Address - Country:US
Mailing Address - Phone:407-252-2646
Mailing Address - Fax:
Practice Address - Street 1:32347 COUNTY ROAD 473
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34788-8801
Practice Address - Country:US
Practice Address - Phone:352-308-8941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-29
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA74675225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist