Provider Demographics
NPI:1689152191
Name:NOVOTNY, ROBIN G (LPTA)
Entity Type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:G
Last Name:NOVOTNY
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:MRS
Other - First Name:ROBIN
Other - Middle Name:KAY
Other - Last Name:GIESEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPTA
Mailing Address - Street 1:5105 MIDDLEBROOK CT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-7977
Mailing Address - Country:US
Mailing Address - Phone:757-438-2899
Mailing Address - Fax:
Practice Address - Street 1:827 NORVIEW AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23509-1540
Practice Address - Country:US
Practice Address - Phone:757-853-6281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-06
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306603316225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant