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General NPI Number Information
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NPI Number | 1225716707
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Entity Type | Individual
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Provider Name | DANIEL JOSEPH NOWAK
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Gender | Male
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Dates
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Enumeration Date | 07/06/2023
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Last Update Date | 07/06/2023
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Provider Practice Location Address
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Address Line | 10095 INVESTMENT WAY
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City | FLORENCE
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State | KY
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Zip | 41042-4798
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Country | US
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Telephone | 606-595-7693
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Fax |
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Provider Business Mailing Address
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Address Line | 755 MEADOW WOOD DR
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City | VILLA HILLS
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State | KY
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Zip | 41017-1256
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Country | US
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Telephone | 606-595-7693
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT955
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License Number State | KY
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