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General NPI Number Information
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NPI Number | 1417472622
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Entity Type | Individual
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Provider Name | KIMBERLY VICTORIA NOWOTNY PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 08/08/2017
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Last Update Date | 05/08/2018
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Provider Practice Location Address
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Address Line | 12605 EAST FWY STE 212
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City | HOUSTON
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State | TX
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Zip | 77015-5619
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Country | US
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Telephone | 713-453-0400
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Fax |
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Provider Business Mailing Address
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Address Line | 1606 LEHMAN ST
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City | HOUSTON
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State | TX
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Zip | 77018-1218
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Country | US
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Telephone | 713-582-6235
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 1296062
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 1296062
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License Number State | TX
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