Provider Demographics
NPI:1104194653
Name:NOEL, DEBRA J (PTA)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:J
Last Name:NOEL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:E2697 ROCKLEDGE RD
Mailing Address - Street 2:
Mailing Address - City:CASCO
Mailing Address - State:WI
Mailing Address - Zip Code:54205-9452
Mailing Address - Country:US
Mailing Address - Phone:920-837-2700
Mailing Address - Fax:920-837-2700
Practice Address - Street 1:N3015 HICKORY RD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:WI
Practice Address - Zip Code:53006-0316
Practice Address - Country:US
Practice Address - Phone:920-933-4344
Practice Address - Fax:866-670-0316
Is Sole Proprietor?:No
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1809-019225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant