Provider Demographics
NPI:1366689614
Name:KOVACH, JEAN M (PT)
Entity Type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:M
Last Name:KOVACH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:JEAN
Other - Middle Name:M
Other - Last Name:HUFNAGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:4853 UPPER MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-9632
Mailing Address - Country:US
Mailing Address - Phone:716-439-5886
Mailing Address - Fax:
Practice Address - Street 1:28 HARDING AVE.
Practice Address - Street 2:LOCKPORT EARLY CHILDHOOD PROGRAM
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094
Practice Address - Country:US
Practice Address - Phone:716-478-4447
Practice Address - Fax:716-478-4427
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007868-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist