Healthcare Provider Details

I. General information

NPI: 1881760338
Provider Name (Legal Business Name): ANDREW NOVICK M.A., P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 RESERVOIR RD NW BLES G-12
WASHINGTON DC
20007-2113
US

IV. Provider business mailing address

3800 RESERVOIR RD NW BLES G-12
WASHINGTON DC
20007-2113
US

V. Phone/Fax

Practice location:
  • Phone: 202-444-3690
  • Fax: 202-444-5333
Mailing address:
  • Phone: 202-444-3690
  • Fax: 202-444-5333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT2699
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: