Healthcare Provider Details

I. General information

NPI: 1073366233
Provider Name (Legal Business Name): MICHAEL NOBLES PT , DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 04/08/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12395 EL CAMINO REAL STE 111
SAN DIEGO CA
92130-3083
US

IV. Provider business mailing address

1275 FAITHFUL WAY
SAN JACINTO CA
92583-4426
US

V. Phone/Fax

Practice location:
  • Phone: 858-488-3597
  • Fax:
Mailing address:
  • Phone: 951-587-1564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number305880
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: