Provider Demographics
NPI:1073195509
Name:HOVESTOL, MARTHA LUCILA VERA (PT)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:LUCILA VERA
Last Name:HOVESTOL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 KENDALE ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-8435
Mailing Address - Country:US
Mailing Address - Phone:209-531-6795
Mailing Address - Fax:
Practice Address - Street 1:94-1181 KA UKA BLVD STE C
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-4485
Practice Address - Country:US
Practice Address - Phone:808-260-9056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-23
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI7712251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics