Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 226300000X | Kinesiotherapist | 1865 | IL |
Y | 226300000X | Kinesiotherapist | 1895 | IL |
N | 226300000X | Kinesiotherapist | 1895 | VA |
NPI | 1861735441 |
---|---|
Provider Name | Mr. Kendall Andre Noble |
First Address | Danville, IL 61832-7954 |
Second Address | Danville, IL 61832-5100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2013 |
Last Update Date | 03/03/2021 |