Provider Demographics
NPI:1972767093
Name:NOVATNY, GEORGIANA TAYLOR (DPT)
Entity Type:Individual
Prefix:
First Name:GEORGIANA
Middle Name:TAYLOR
Last Name:NOVATNY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:GEORGIANA
Other - Middle Name:TAYLOR
Other - Last Name:CUNKELMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:31 PLYMOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15906-1815
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:969 EISENHOWER BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-3326
Practice Address - Country:US
Practice Address - Phone:814-269-4355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT019352225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist