Provider Demographics
NPI:1083927461
Name:KOSTOVICK, NANCY HAHN (PT)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:HAHN
Last Name:KOSTOVICK
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 1:189 HOLMES RD
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9129
Mailing Address - Country:US
Mailing Address - Phone:207-883-8889
Mailing Address - Fax:
Practice Address - Street 1:189 HOLMES RD
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-9129
Practice Address - Country:US
Practice Address - Phone:207-883-8889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT877225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist