MEDICARE: MARK ALFRED NOBLE PT, DPT

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	LPT-31415	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LPT-31415	OTHER	AZ	ARIZONA STATE BOARD OF PHYSICAL THERAPY

General Provider Information

NPI Number	:	1902415607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK ALFRED NOBLE PT, DPT

Provider Business Mailing Address
First Line	:	17233 N HOLMES BLVD STE 1650
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85053-2031
Country	:	US
Telephone Number	:	602-547-1836
Fax Number	:

Provider Business Practice Location Address
First Line	:	17233 N HOLMES BLVD STE 1650
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85053-2031
Country	:	US
Telephone Number	:	602-547-1836
Fax Number	:

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

Provider Enumeration Date	:	07/28/2020
Last Update Date	:	09/14/2020

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