MEDICARE: MIKE NOONAN PHYSICAL THERAPY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1786	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457461360
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIKE NOONAN PHYSICAL THERAPY, LLC

Provider Business Mailing Address
First Line	:	5956 E PIMA ST
Second Line	:	STE 100
City	:	TUCSON
State	:	AZ
Zip	:	85712-4375
Country	:	US
Telephone Number	:	520-885-4636
Fax Number	:	520-885-4736

Provider Business Practice Location Address
First Line	:	5956 E PIMA ST
Second Line	:	STE 100
City	:	TUCSON
State	:	AZ
Zip	:	85712-4375
Country	:	US
Telephone Number	:	520-885-4636
Fax Number	:	520-885-4736

Authorized Official
Title or Position	:	PT, DPT
Name	:	MR. MICHAEL R. NOONAN
Credential	:
Telephone Number	:	520-885-4636

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	04/10/2017

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