Provider Demographics
NPI:1407372527
Name:NOONAN, NICOLE MEGAN (DPT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:MEGAN
Last Name:NOONAN
Suffix:
Gender:
Credentials:DPT
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:MEGAN
Other - Last Name:HAVLIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16 MAYBROOK RD STE L
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL HALL
Mailing Address - State:NY
Mailing Address - Zip Code:10916-2741
Mailing Address - Country:US
Mailing Address - Phone:845-636-4344
Mailing Address - Fax:845-636-4355
Practice Address - Street 1:246 MAIN ST STE 8
Practice Address - Street 2:
Practice Address - City:NEW PALTZ
Practice Address - State:NY
Practice Address - Zip Code:12561-1621
Practice Address - Country:US
Practice Address - Phone:845-419-5033
Practice Address - Fax:845-419-5106
Is Sole Proprietor?:No
Enumeration Date:2017-08-21
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041876225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist