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General NPI Number Information
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NPI Number | 1861424202
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Entity Type | Individual
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Provider Name | JEROME NOVAK PT
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Gender | Male
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 08/19/2025
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Provider Practice Location Address
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Address Line | 6123 GREEN BAY RD STE 100
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City | KENOSHA
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State | WI
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Zip | 53142-2939
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Country | US
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Telephone | 262-880-1034
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Fax | 888-972-3708
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Provider Business Mailing Address
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Address Line | 12121 45TH AVE
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City | PLEASANT PRAIRIE
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State | WI
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Zip | 53158-3901
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Country | US
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Telephone | 262-880-1034
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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 | 070-013596
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 9800-024
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License Number State | WI
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