Provider Demographics
NPI:1942373048
Name:NOVAK, LYDIA T (PT)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:T
Last Name:NOVAK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:14640 JOHN HUMPHREY DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-5854
Mailing Address - Country:US
Mailing Address - Phone:708-403-5199
Mailing Address - Fax:708-403-7274
Practice Address - Street 1:14640 JOHN HUMPHREY DR
Practice Address - Street 2:SUITE 102
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-5854
Practice Address - Country:US
Practice Address - Phone:708-403-5199
Practice Address - Fax:708-403-7274
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL225100000X, 2251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic