Provider Demographics
NPI:1366872012
Name:NOEL, ZACHARY TYLER (LAT,ATC)
Entity type:Individual
Prefix:MR
First Name:ZACHARY
Middle Name:TYLER
Last Name:NOEL
Suffix:
Gender:M
Credentials:LAT,ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:17345-1508
Mailing Address - Country:US
Mailing Address - Phone:717-817-8601
Mailing Address - Fax:
Practice Address - Street 1:300 HIGH ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:PA
Practice Address - Zip Code:17345-1508
Practice Address - Country:US
Practice Address - Phone:717-817-8601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-16
Last Update Date:2013-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0055692255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer