Provider Demographics
NPI:1114630381
Name:NOBLE, ELISHEVA A (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:ELISHEVA
Middle Name:A
Last Name:NOBLE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14741 76TH AVE APT 1C
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-3102
Mailing Address - Country:US
Mailing Address - Phone:718-801-1923
Mailing Address - Fax:
Practice Address - Street 1:14741 76TH AVE APT 1C
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-3102
Practice Address - Country:US
Practice Address - Phone:718-801-1923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049628225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist