MEDICARE: MRS. GINA MARIE MARTINELLI NOBLE MPT, ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT 013580L	PA

General Provider Information

NPI Number	:	1225051386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GINA MARIE MARTINELLI NOBLE MPT, ATC

Provider Business Mailing Address
First Line	:	1161 MCDERMOTT DR
Second Line	:
City	:	WEST CHESTER
State	:	PA
Zip	:	19380-4064
Country	:	US
Telephone Number	:	484-356-9401
Fax Number	:

Provider Business Practice Location Address
First Line	:	525 W CHESTER PIKE
Second Line	:	SUITE 202
City	:	HAVERTOWN
State	:	PA
Zip	:	19083-4500
Country	:	US
Telephone Number	:	610-446-8410
Fax Number	:	610-446-8554

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	10/18/2012

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