MEDICARE: SYDNEY NOVAK PT, 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	PT42548	FL

General Provider Information

NPI Number	:	1861218380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYDNEY NOVAK PT, DPT

Provider Business Mailing Address
First Line	:	470 MALABAR RD SE UNIT 102
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32907-3124
Country	:	US
Telephone Number	:	321-802-9645
Fax Number	:	321-802-9647

Provider Business Practice Location Address
First Line	:	470 MALABAR RD SE UNIT 102
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32907-3124
Country	:	US
Telephone Number	:	321-802-9645
Fax Number	:	321-802-9647

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

Provider Enumeration Date	:	11/30/2024
Last Update Date	:	11/30/2024

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