Provider Demographics
NPI:1891904769
Name:NOVAK, JOEL N (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:N
Last Name:NOVAK
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6922 HILLSDALE CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2040
Mailing Address - Country:US
Mailing Address - Phone:317-621-7820
Mailing Address - Fax:317-621-7824
Practice Address - Street 1:6922 HILLSDALE CT
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-2040
Practice Address - Country:US
Practice Address - Phone:317-621-7820
Practice Address - Fax:317-621-7824
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05009314A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN156529Medicare ID - Type Unspecified