Healthcare Provider Details

I. General information

NPI: 1700234895
Provider Name (Legal Business Name): LAURA E NOWAC PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2016
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 UNITED WAY
MEDFORD OR
97504-4970
US

IV. Provider business mailing address

3633 HARBROOKE RD
MEDFORD OR
97504-9312
US

V. Phone/Fax

Practice location:
  • Phone: 541-773-2999
  • Fax:
Mailing address:
  • Phone: 541-499-7625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5564
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: