Provider Demographics
NPI:1528223724
Name:NOVALES, MARY STEPHANIE LIBERATO (RPT)
Entity Type:Individual
Prefix:
First Name:MARY STEPHANIE
Middle Name:LIBERATO
Last Name:NOVALES
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:9567 FRONTIER ST
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-8333
Mailing Address - Country:US
Mailing Address - Phone:317-508-6844
Mailing Address - Fax:317-774-1403
Practice Address - Street 1:9567 FRONTIER ST
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-8333
Practice Address - Country:US
Practice Address - Phone:317-508-6844
Practice Address - Fax:317-774-1403
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN05003475A2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics