Provider Demographics
NPI:1477920338
Name:COVE, STEFANIE (PT)
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:
Last Name:COVE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:STEFANIE
Other - Middle Name:
Other - Last Name:WREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1450 NORTHWEST BLVD.
Mailing Address - Street 2:SUITE 106
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-5605
Mailing Address - Country:US
Mailing Address - Phone:208-667-6264
Mailing Address - Fax:208-664-4313
Practice Address - Street 1:1450 NORTHWEST BLVD.
Practice Address - Street 2:SUITE 106
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-5605
Practice Address - Country:US
Practice Address - Phone:208-667-6264
Practice Address - Fax:208-664-4313
Is Sole Proprietor?:No
Enumeration Date:2015-08-27
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05009932A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000965379OtherANTHEM PROVIDER NUMBER
IN201324760Medicaid
IN815500130Medicare PIN