Provider Demographics
NPI:1750409363
Name:NATIVIDAD, NOEL EULOGIO (PT)
Entity type:Individual
Prefix:
First Name:NOEL
Middle Name:EULOGIO
Last Name:NATIVIDAD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 LONG RUN RD
Mailing Address - Street 2:
Mailing Address - City:PINE GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:17963-9020
Mailing Address - Country:US
Mailing Address - Phone:570-739-2176
Mailing Address - Fax:
Practice Address - Street 1:918 LONG RUN RD
Practice Address - Street 2:
Practice Address - City:PINE GROVE
Practice Address - State:PA
Practice Address - Zip Code:17963-9020
Practice Address - Country:US
Practice Address - Phone:570-739-2176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT016277225100000X
NY025322-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist