Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 14418 | MD |
NPI | 1124597885 |
---|---|
Provider Name | Christine Novick |
First Address | Gaithersburg, MD 20877-5100 |
Second Address | Gaithersburg, MD 20877-5100 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/11/2018 |
Last Update Date | 24/11/2018 |