Provider Demographics
NPI:1578525713
Name:KOVAC, KIM (MS PT CHT)
Entity Type:Individual
Prefix:MS
First Name:KIM
Middle Name:
Last Name:KOVAC
Suffix:
Gender:F
Credentials:MS PT CHT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 BOULDERS PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23225-4067
Mailing Address - Country:US
Mailing Address - Phone:804-560-5595
Mailing Address - Fax:804-560-9029
Practice Address - Street 1:7650 E PARHAM RD
Practice Address - Street 2:SUITE 100
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23294-4373
Practice Address - Country:US
Practice Address - Phone:804-282-6338
Practice Address - Fax:804-285-3237
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305004075225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010200768Medicaid
VA192953OtherBCBS (PHYSICAL THERAPY)
710746OtherAETNA
VAP00263215OtherRAILROAD MEDICARE
VAC05954Medicare PIN
VA192953OtherBCBS (PHYSICAL THERAPY)