Healthcare Provider Details

I. General information

NPI: 1417923566
Provider Name (Legal Business Name): MICHAEL S NOONAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 06/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 TOWER HILL RD
NORTH KINGSTOWN RI
02852-4814
US

IV. Provider business mailing address

300 TOWER HILL RD
NORTH KINGSTOWN RI
02852-4814
US

V. Phone/Fax

Practice location:
  • Phone: 401-295-8500
  • Fax: 401-295-8536
Mailing address:
  • Phone: 401-295-8500
  • Fax: 401-295-8536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number621
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4262
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: