Healthcare Provider Details

I. General information

NPI: 1336777861
Provider Name (Legal Business Name): DANIELLE NOVAK PT,DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 03/31/2020
Certification Date: 03/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

399 FARMINGTON AVE
FARMINGTON CT
06032-1936
US

IV. Provider business mailing address

27 BRIAN RD
WEST HARTFORD CT
06110-2508
US

V. Phone/Fax

Practice location:
  • Phone: 860-837-7301
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number12322
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: