Basic Information
| Provider Information | |||||||||
| NPI: | 1063889400 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NOONAN | ||||||||
| FirstName: | SEAN | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 278 GENESEE ST | ||||||||
| Address2: | |||||||||
| City: | AUBURN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130213231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3152820067 | ||||||||
| FaxNumber: | 3152820587 | ||||||||
| Practice Location | |||||||||
| Address1: | 1991 FORDHAM DR | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283043773 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9104844653 | ||||||||
| FaxNumber: | 9104839256 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2015 | ||||||||
| LastUpdateDate: | 08/30/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 039246-1 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.