Provider Demographics
NPI:1992354278
Name:NOVAK, LAURA (PT, DPT)
Entity type:Individual
Prefix:
First Name:LAURA
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 1:1713 ANDOVER CT
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGE
Mailing Address - State:OK
Mailing Address - Zip Code:73120-1101
Mailing Address - Country:US
Mailing Address - Phone:706-248-7270
Mailing Address - Fax:
Practice Address - Street 1:5110 S YALE AVE STE 102
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-7438
Practice Address - Country:US
Practice Address - Phone:918-492-2386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-09
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5746225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist