Healthcare Provider Details

I. General information

NPI: 1033629324
Provider Name (Legal Business Name): CAITLIN NORA NOBLE PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2017
Last Update Date: 10/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46001 GRAND RIVER AVE STE A
NOVI MI
48374-1319
US

IV. Provider business mailing address

8620 COUNTRY CLUB DR
PINCKNEY MI
48169-8253
US

V. Phone/Fax

Practice location:
  • Phone: 248-513-3003
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number5501018452
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: