Individual
NICOLE NOVOTNY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
2455 MISSOURI AVE, SUITE B, LAS CRUCES, NM 88001-5122
(575) 556-8440
(575) 556-8439
Mailing address
2455 MISSOURI AVE, SUITE B, LAS CRUCES, NM 88001-5122
(575) 556-8440
(575) 556-8439
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2026
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
87750066
—
NM
01
—
NM00Q517
BCBS NM
NM
Enumeration date
10/07/2005
Last updated
04/29/2015
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