Provider Demographics
NPI:1427067834
Name:NOWICK, PATRICIA ANN (RPT)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:ANN
Last Name:NOWICK
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2416 HIGHWAY 45 N
Mailing Address - Street 2:SUITE 10
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-1320
Mailing Address - Country:US
Mailing Address - Phone:662-327-6705
Mailing Address - Fax:662-327-6760
Practice Address - Street 1:1355 W ROGERS BLVD
Practice Address - Street 2:SUITE 10
Practice Address - City:SKIATOOK
Practice Address - State:OK
Practice Address - Zip Code:74070-4204
Practice Address - Country:US
Practice Address - Phone:918-396-7125
Practice Address - Fax:918-396-7186
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2016-02-16
Deactivation Date:
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Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040-0001011225100000X
OK4805225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1018958Medicaid
VT1018958Medicaid