Provider Demographics
NPI:1912680935
Name:ESBENSHADE, NOAH JAMES
Entity Type:Individual
Prefix:
First Name:NOAH
Middle Name:JAMES
Last Name:ESBENSHADE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5425 JONESTOWN RD STE 100
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-4086
Mailing Address - Country:US
Mailing Address - Phone:717-901-9487
Mailing Address - Fax:
Practice Address - Street 1:5425 JONESTOWN RD STE 100
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-4086
Practice Address - Country:US
Practice Address - Phone:717-901-9487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA031477225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist