Provider Demographics
NPI:1275772030
Name:NOVAK, KATIE ANN (DPT)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:ANN
Last Name:NOVAK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:ANN
Other - Last Name:CORELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:110 N ANKENY BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-1756
Mailing Address - Country:US
Mailing Address - Phone:515-964-9100
Mailing Address - Fax:515-964-2700
Practice Address - Street 1:110 N ANKENY BLVD STE 100
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-1756
Practice Address - Country:US
Practice Address - Phone:515-964-9100
Practice Address - Fax:515-964-2700
Is Sole Proprietor?:No
Enumeration Date:2009-02-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004352225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA004352OtherIOWA PT LICENSE