MEDICARE: EMILY MITIGUY NOVOA DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT60543495	WA

General Provider Information

NPI Number	:	1235493636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY MITIGUY NOVOA DPT

Provider Business Mailing Address
First Line	:	PO BOX 5299
Second Line	:	MS: 820-5-PCO
City	:	TACOMA
State	:	WA
Zip	:	98415-0299
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 MCPHEE RD SW BLDG 1
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98502-5080
Country	:	US
Telephone Number	:	360-596-4614
Fax Number	:	360-596-4615

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2012
Last Update Date	:	01/10/2024

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