Provider Demographics
NPI:1487889986
Name:NOVICK, ANNE MICHELLE (DPT)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:MICHELLE
Last Name:NOVICK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 STIERLIN RD
Mailing Address - Street 2:#50
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94043-4651
Mailing Address - Country:US
Mailing Address - Phone:650-815-8949
Mailing Address - Fax:
Practice Address - Street 1:638 MAYBELL AVE
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-3815
Practice Address - Country:US
Practice Address - Phone:650-845-3005
Practice Address - Fax:650-856-6935
Is Sole Proprietor?:No
Enumeration Date:2009-05-28
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 32152174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist