Provider Demographics
NPI:1093174062
Name:NOVAK, JESSICA M (PT, DPT)
Entity Type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:M
Last Name:NOVAK
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 MACARTHUR AVE.
Mailing Address - Street 2:SUITE 170
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75209-6532
Mailing Address - Country:US
Mailing Address - Phone:214-579-9781
Mailing Address - Fax:214-579-9673
Practice Address - Street 1:4300 MACARTHUR AVE.
Practice Address - Street 2:SUITE 170
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75209
Practice Address - Country:US
Practice Address - Phone:214-579-9781
Practice Address - Fax:214-579-9673
Is Sole Proprietor?:No
Enumeration Date:2016-02-18
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1271731225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist