Provider Demographics
NPI:1093715765
Name:NOWAK, JOSEPH HENRY (PT, DPT)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:HENRY
Last Name:NOWAK
Suffix:
Gender:M
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 1:640 SUMMIT CROSSING PLACE
Mailing Address - Street 2:#208
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054
Mailing Address - Country:US
Mailing Address - Phone:704-671-5730
Mailing Address - Fax:704-671-5750
Practice Address - Street 1:1385 E GARRISON BLVD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-5127
Practice Address - Country:US
Practice Address - Phone:704-864-4424
Practice Address - Fax:704-864-2125
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9298225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3484636OtherAETNA HMO/QPOS
NC7211588Medicaid
NCD3290OtherMEDCOST
NC079AGOtherBLUE CROSS/BLUE SHIELD
NC7662579OtherAETNA PPO/POS
NC2505158Medicare ID - Type Unspecified