MEDICARE: LYDIA T NOVAK PT

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	225100000X	Physical Therapist	IL
2	2251S0007X	Sports Physical Therapist	IL
3	2251X0800X	Orthopedic Physical Therapist	IL

General Provider Information

NPI Number	:	1942373048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYDIA T NOVAK PT

Provider Business Mailing Address
First Line	:	14640 JOHN HUMPHREY DR
Second Line	:	SUITE 102
City	:	ORLAND PARK
State	:	IL
Zip	:	60462-5854
Country	:	US
Telephone Number	:	708-403-5199
Fax Number	:	708-403-7274

Provider Business Practice Location Address
First Line	:	14640 JOHN HUMPHREY DR
Second Line	:	SUITE 102
City	:	ORLAND PARK
State	:	IL
Zip	:	60462-5854
Country	:	US
Telephone Number	:	708-403-5199
Fax Number	:	708-403-7274

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	03/11/2008

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