Provider Demographics
NPI:1447070669
Name:NOWICKI, JACQUELINE RAE (PT, DPT)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:RAE
Last Name:NOWICKI
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:RAE
Other - Last Name:ALFHEIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:1817 BONHAM LN
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-2512
Mailing Address - Country:US
Mailing Address - Phone:602-760-6622
Mailing Address - Fax:
Practice Address - Street 1:201 SETON PKWY
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-8000
Practice Address - Country:US
Practice Address - Phone:512-324-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-14
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1365010225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist