MEDICARE: MR. RICHARD NOWAK P.T., OCS

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	PT10419	CA

General Provider Information

NPI Number	:	1295824266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICHARD NOWAK P.T., OCS

Provider Business Mailing Address
First Line	:	5239 BARELA AVENUE
Second Line	:
City	:	TEMPLE CITY
State	:	CA
Zip	:	91780
Country	:	US
Telephone Number	:	626-407-0300
Fax Number	:	626-407-0311

Provider Business Practice Location Address
First Line	:	5239 BARELA AVE
Second Line	:
City	:	TEMPLE CITY
State	:	CA
Zip	:	91780-3849
Country	:	US
Telephone Number	:	626-407-0300
Fax Number	:

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

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	07/08/2007

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