Provider Demographics
NPI:1427353382
Name:NOLL, VICKY LYNN (CMT)
Entity type:Individual
Prefix:
First Name:VICKY
Middle Name:LYNN
Last Name:NOLL
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:VICKY
Other - Middle Name:
Other - Last Name:NOLL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA LICENSURE
Mailing Address - Street 1:206 MOUNT JOY ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT JOY
Mailing Address - State:PA
Mailing Address - Zip Code:17552
Mailing Address - Country:US
Mailing Address - Phone:717-824-1509
Mailing Address - Fax:
Practice Address - Street 1:206 MOUNT JOY ST
Practice Address - Street 2:
Practice Address - City:MOUNT JOY
Practice Address - State:PA
Practice Address - Zip Code:17552-1522
Practice Address - Country:US
Practice Address - Phone:717-824-1509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-24
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist