Provider Demographics
NPI:1245957927
Name:NOVAK, KAYLENE (PT)
Entity type:Individual
Prefix:
First Name:KAYLENE
Middle Name:
Last Name:NOVAK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9645 LINCOLNWAY LN
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-1866
Mailing Address - Country:US
Mailing Address - Phone:815-464-0101
Mailing Address - Fax:815-464-9191
Practice Address - Street 1:9645 LINCOLNWAY LN
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-1866
Practice Address - Country:US
Practice Address - Phone:815-464-0101
Practice Address - Fax:815-464-9191
Is Sole Proprietor?:No
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.026957225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist