Basic Information
| Provider Information | |||||||||
| NPI: | 1336412733 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LORI C. NOVICH-WELTER, M.D., P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 267 N SPRING CREEK PKWY | ||||||||
| Address2: | |||||||||
| City: | PROVIDENCE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 843329775 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4357929400 | ||||||||
| FaxNumber: | 4357924800 | ||||||||
| Practice Location | |||||||||
| Address1: | 267 N SPRING CREEK PKWY | ||||||||
| Address2: | |||||||||
| City: | PROVIDENCE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 843329775 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4357929400 | ||||||||
| FaxNumber: | 4357924800 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2012 | ||||||||
| LastUpdateDate: | 01/16/2014 | ||||||||
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| AuthorizedOfficialLastName: | NOVICH-WELTER | ||||||||
| AuthorizedOfficialFirstName: | LORI | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4357929400 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | M-10473 | ID | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 208100000X | 5924248 | UT | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.