Provider Demographics
NPI:1205386679
Name:KOVAL, ALENA
Entity Type:Individual
Prefix:
First Name:ALENA
Middle Name:
Last Name:KOVAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5235 DOUBLE BRANCHES DR
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-6360
Mailing Address - Country:US
Mailing Address - Phone:770-789-6767
Mailing Address - Fax:
Practice Address - Street 1:5235 DOUBLE BRANCHES DR
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-6360
Practice Address - Country:US
Practice Address - Phone:770-789-6767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-10
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003630225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant