MEDICARE: DOUGLAS STEPHEN NOEL PT

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	PT018742	PA
2	225100000X	Physical Therapist	PT29609	FL

General Provider Information

NPI Number	:	1447458468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS STEPHEN NOEL PT

Provider Business Mailing Address
First Line	:	4322 S HALE AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33611-1332
Country	:	US
Telephone Number	:	814-934-3179
Fax Number	:

Provider Business Practice Location Address
First Line	:	4107 N HIMES AVE
Second Line	:	SUITE 100
City	:	TAMPA
State	:	FL
Zip	:	33607-6655
Country	:	US
Telephone Number	:	813-874-1009
Fax Number	:	813-872-6717

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

Provider Enumeration Date	:	07/11/2007
Last Update Date	:	12/09/2015

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Directions to “ DOUGLAS STEPHEN NOEL PT” Practice Location

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