Provider Demographics
NPI:1235361668
Name:NOWAK, MEREDITH TYRA (PT)
Entity Type:Individual
Prefix:MRS
First Name:MEREDITH
Middle Name:TYRA
Last Name:NOWAK
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 1:5214 ELIOT PL
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-3850
Mailing Address - Country:US
Mailing Address - Phone:760-212-1534
Mailing Address - Fax:858-369-5260
Practice Address - Street 1:5214 ELIOT PL
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-3850
Practice Address - Country:US
Practice Address - Phone:760-212-1534
Practice Address - Fax:858-369-5260
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-18
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15193225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist