Healthcare Provider Details

I. General information

NPI: 1063889400
Provider Name (Legal Business Name): SEAN NOONAN DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2015
Last Update Date: 08/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1991 FORDHAM DR SUITE 102
FAYETTEVILLE NC
28304-3773
US

IV. Provider business mailing address

278 GENESEE ST
AUBURN NY
13021-3231
US

V. Phone/Fax

Practice location:
  • Phone: 910-484-4653
  • Fax: 910-483-9256
Mailing address:
  • Phone: 315-282-0067
  • Fax: 315-282-0587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number039246-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: