Provider Demographics
NPI:1801920699
Name:NOVOTNY, BERNADETTE (PTA)
Entity type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:
Last Name:NOVOTNY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:836 180TH AVE
Mailing Address - Street 2:
Mailing Address - City:GARFIELD
Mailing Address - State:KS
Mailing Address - Zip Code:67529
Mailing Address - Country:US
Mailing Address - Phone:615-896-6400
Mailing Address - Fax:
Practice Address - Street 1:1114 W 11 ST
Practice Address - Street 2:
Practice Address - City:LEARNED
Practice Address - State:KS
Practice Address - Zip Code:67550
Practice Address - Country:US
Practice Address - Phone:615-896-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1400550225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant