Provider Demographics
NPI:1194993022
Name:NOELCK, GREGORY
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:NOELCK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2911 SE VILLAGE LOOP
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-8103
Mailing Address - Country:US
Mailing Address - Phone:360-433-6346
Mailing Address - Fax:360-891-4532
Practice Address - Street 1:2911 SE VILLAGE LOOP
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-8103
Practice Address - Country:US
Practice Address - Phone:360-433-6346
Practice Address - Fax:360-891-4532
Is Sole Proprietor?:No
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00010733225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist