MEDICARE: JESSICA NOVAK, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1790493997
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JESSICA NOVAK, PLLC

Provider Business Mailing Address
First Line	:	8450 SWEETWATER DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75228-5844
Country	:	US
Telephone Number	:	806-236-4726
Fax Number	:

Provider Business Practice Location Address
First Line	:	4411 BELMONT AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75204-3004
Country	:	US
Telephone Number	:	806-236-4726
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	DR. JESSICA NOVAK
Credential	:	PT, DPT
Telephone Number	:	806-236-4726

Provider Enumeration Date	:	11/07/2022
Last Update Date	:	11/07/2022

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