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NPI Code Detail

MEDICARE: GREGORY NOGA PTA

MEDICARE: GREGORY NOGA PTA
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
1225200000XPhysical Therapy Assistant7527AAZ

General Provider Information

NPI Number : 1649393141
Entity Type Code : Individual
Provider Name (Legal Business Name) : GREGORY NOGA PTA
Provider Business Mailing Address
First Line : 7901 E HOLMES AVE
Second Line :
City : MESA
State : AZ
Zip : 85209-9124
Country : US
Telephone Number : 480-510-4956
Fax Number :
Provider Business Practice Location Address
First Line : 5121 E BROADWAY RD
Second Line :
City : MESA
State : AZ
Zip : 85206-1308
Country : US
Telephone Number : 480-832-5555
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/09/2007
Last Update Date : 12/01/2008

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Directions to “ GREGORY NOGA PTA” Practice Location

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