MEDICARE: NOAH MULDER

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	11-07927	KS

General Provider Information

NPI Number	:	1275420101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NOAH MULDER

Provider Business Mailing Address
First Line	:	2106 W 75TH ST
Second Line	:
City	:	PRAIRIE VILLAGE
State	:	KS
Zip	:	66208-3503
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2106 W 75TH ST
Second Line	:
City	:	PRAIRIE VILLAGE
State	:	KS
Zip	:	66208-3503
Country	:	US
Telephone Number	:	913-291-2290
Fax Number	:

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

Provider Enumeration Date	:	06/23/2025
Last Update Date	:	06/23/2025

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Directions to “ NOAH MULDER ” Practice Location

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