Provider Demographics
NPI:1881653939
Name:NOVICK, KATHLEEN A (MA PT)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:A
Last Name:NOVICK
Suffix:
Gender:F
Credentials:MA PT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:320-3 MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701
Mailing Address - Country:US
Mailing Address - Phone:631-691-5338
Mailing Address - Fax:631-691-0723
Practice Address - Street 1:320-3 MERRICK RD
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701
Practice Address - Country:US
Practice Address - Phone:631-691-5338
Practice Address - Fax:631-691-0723
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-18
Last Update Date:2008-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPT0023941225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
10456308OtherCHQH
10456308OtherCHQH