Provider Demographics
NPI:1356854939
Name:NOVY, CHRISTIAN JAMES (MS, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:JAMES
Last Name:NOVY
Suffix:
Gender:M
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10913 SYLVAN VISTA DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:IL
Mailing Address - Zip Code:62254-2334
Mailing Address - Country:US
Mailing Address - Phone:618-973-9181
Mailing Address - Fax:
Practice Address - Street 1:10913 SYLVAN VISTA DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:IL
Practice Address - Zip Code:62254-2334
Practice Address - Country:US
Practice Address - Phone:618-973-9181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-06
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096.0045012255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer