Provider Demographics
NPI:1720125982
Name:NOVAK, MARSHA (PT)
Entity Type:Individual
Prefix:
First Name:MARSHA
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 1:140 SADIE LN NW
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-1796
Mailing Address - Country:US
Mailing Address - Phone:206-842-4608
Mailing Address - Fax:206-547-8327
Practice Address - Street 1:381 WALLACE WAY NE
Practice Address - Street 2:UNIT 101- A
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-2868
Practice Address - Country:US
Practice Address - Phone:206-842-4608
Practice Address - Fax:206-547-8327
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00003357225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA124016OtherSATE LABOR & INDUSTRIES