Provider Demographics
NPI:1205960531
Name:NOVAK, LORI ANN (PT)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:ANN
Last Name:NOVAK
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 1:2000 WILCOX CIR
Mailing Address - Street 2:
Mailing Address - City:MURRYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15668-2603
Mailing Address - Country:US
Mailing Address - Phone:724-733-0585
Mailing Address - Fax:724-942-1963
Practice Address - Street 1:2000 WILCOX CIR
Practice Address - Street 2:
Practice Address - City:MURRYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15668-2603
Practice Address - Country:US
Practice Address - Phone:724-733-0585
Practice Address - Fax:724-942-1963
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT005598L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019110900004Medicaid