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Individual

MS. LISA M NOLDEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PTA

Contact information

Practice address
1663 BELVIDERE RD, BELVIDERE, IL 61008-9306
(815) 544-0040
(815) 544-0048
Mailing address
PO BOX 2176, DEPT 5389, MILWAUKEE, WI 53201-2176
(815) 713-2600
(815) 654-8020

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160004668
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
160004668
IL LICENSE
IL
01
769380
MEDICARE GROUP PTAN
IL
Enumeration date
08/02/2010
Last updated
08/02/2010
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