Healthcare Provider Details

I. General information

NPI: 1417017500
Provider Name (Legal Business Name): JOSEPH R NOEL PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 E WHITING ST APT 202
TAMPA FL
33602-4106
US

IV. Provider business mailing address

13020 N TELECOM PKWY UNIT 202
TEMPLE TERRACE FL
33637-0925
US

V. Phone/Fax

Practice location:
  • Phone: 813-505-9328
  • Fax:
Mailing address:
  • Phone: 813-978-9700
  • Fax: 813-558-6186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT6617
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT6617
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: