Healthcare Provider Details

I. General information

NPI: 1710931944
Provider Name (Legal Business Name): NOONAN PHYSICAL THERAPY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4968 MOUNTAIN RD
STOWE VT
05672-4885
US

IV. Provider business mailing address

4968 MOUNTAIN RD PO BOX 3421
STOWE VT
05672-4885
US

V. Phone/Fax

Practice location:
  • Phone: 802-253-5694
  • Fax: 802-253-5697
Mailing address:
  • Phone: 802-253-5694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: HEIDI NOONAN
Title or Position: PRESIDENT
Credential: PT
Phone: 802-253-5694