Provider Demographics
NPI:1407693674
Name:NOVAK, CASSANDRA (PT, DPT)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:NOVAK
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 E PADONIA RD STE 104
Mailing Address - Street 2:
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-2347
Mailing Address - Country:US
Mailing Address - Phone:410-823-8061
Mailing Address - Fax:
Practice Address - Street 1:30 E PADONIA RD STE 104
Practice Address - Street 2:
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-2347
Practice Address - Country:US
Practice Address - Phone:410-823-8061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-13
Last Update Date:2024-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD29510225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist