Healthcare Provider Details

I. General information

NPI: 1649551847
Provider Name (Legal Business Name): NOELLE MARIA HOAG MS, ATC, LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2011
Last Update Date: 08/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

734 E LANCASTER AVE
VILLANOVA PA
19085-1325
US

IV. Provider business mailing address

2397 W COLONIAL DR
UPPER CHICHESTER PA
19061-2025
US

V. Phone/Fax

Practice location:
  • Phone: 610-254-8001
  • Fax:
Mailing address:
  • Phone: 610-637-7848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT004889
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: