Provider Demographics
NPI:1124344395
Name:NOWAK, KRISTEN LYNN (PTA)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:LYNN
Last Name:NOWAK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MURRAY MEADOWS LN
Mailing Address - Street 2:
Mailing Address - City:RINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17967-9503
Mailing Address - Country:US
Mailing Address - Phone:570-590-4153
Mailing Address - Fax:
Practice Address - Street 1:106 ROTARY DR
Practice Address - Street 2:
Practice Address - City:WEST HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18202-1182
Practice Address - Country:US
Practice Address - Phone:570-459-6333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-13
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA08 0870519225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant