Provider Demographics
NPI:1639260136
Name:NOVAK, DAVID A (AT,C, MHA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:NOVAK
Suffix:
Gender:M
Credentials:AT,C, MHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5955 RICELAND DR
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-1891
Mailing Address - Country:US
Mailing Address - Phone:812-490-1339
Mailing Address - Fax:812-477-3639
Practice Address - Street 1:958 S KENMORE DR
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-7513
Practice Address - Country:US
Practice Address - Phone:812-477-5003
Practice Address - Fax:812-477-3639
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36000472A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer