Provider Demographics
NPI:1477851988
Name:NOVACK, MARILYN LOUISE (LPTA)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:LOUISE
Last Name:NOVACK
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6969 JUSTIN CT E
Mailing Address - Street 2:
Mailing Address - City:REMINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22734-9464
Mailing Address - Country:US
Mailing Address - Phone:703-409-7037
Mailing Address - Fax:
Practice Address - Street 1:6969 JUSTIN CT E
Practice Address - Street 2:
Practice Address - City:REMINGTON
Practice Address - State:VA
Practice Address - Zip Code:22734-9464
Practice Address - Country:US
Practice Address - Phone:703-409-7037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-08
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306000375225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant