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NPI Code Detail

MEDICARE: NOELLE PHILLIPS PT

MEDICARE: NOELLE PHILLIPS 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
1225100000XPhysical TherapistPT24252FL

General Provider Information

NPI Number : 1457599011
Entity Type Code : Individual
Provider Name (Legal Business Name) : NOELLE PHILLIPS PT
Provider Business Mailing Address
First Line : 1917 NEWFOUND HARBOR DR
Second Line :
City : MERRITT ISLAND
State : FL
Zip : 32952-2844
Country : US
Telephone Number : 407-227-7781
Fax Number : 321-456-9906
Provider Business Practice Location Address
First Line : 5650 S WASHINGTON AVE
Second Line : PARRISH PEDIATRIC REHAB
City : TITUSVILLE
State : FL
Zip : 32780-7312
Country : US
Telephone Number : 321-360-9288
Fax Number : 321-456-9906
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/04/2009
Last Update Date : 09/24/2013

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