Provider Demographics
NPI:1053856864
Name:NOVO PHYSICAL THERAPY
Entity Type:Organization
Organization Name:NOVO PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:REBECCA
Authorized Official - Last Name:INFANTE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:214-228-6547
Mailing Address - Street 1:4470 E HIGHWAY 287 STE 800
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-7555
Mailing Address - Country:US
Mailing Address - Phone:972-903-9057
Mailing Address - Fax:972-852-9073
Practice Address - Street 1:4470 E HIGHWAY 287 STE 800
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-7555
Practice Address - Country:US
Practice Address - Phone:972-903-9057
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-03
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1233286261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy