Individual
MICHAEL VICTOR NOWACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.T
Contact information
Practice address
6186 W MAINE, SPIRIT LAKE, ID 83869
(208) 623-6717
Mailing address
PO BOX 3482, POST FALLS, ID 83877-3482
(208) 209-6170
(208) 209-6169
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT00009579
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0201431
LABOR AND INDUSTRIES
WA
05
—
8446924
—
WA
Enumeration date
10/03/2006
Last updated
11/30/2015
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