Provider Demographics
NPI:1881065886
Name:EITAN, NOAM (PT)
Entity type:Individual
Prefix:
First Name:NOAM
Middle Name:
Last Name:EITAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 PARK AVENUE EXT
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-2653
Mailing Address - Country:US
Mailing Address - Phone:443-889-8347
Mailing Address - Fax:
Practice Address - Street 1:10 SEWALL AVE STE 211
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5154
Practice Address - Country:US
Practice Address - Phone:617-890-6026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-15
Last Update Date:2025-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPTL2336225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist