Provider Demographics
NPI:1689018590
Name:KOVACHY, ANDREW J (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:J
Last Name:KOVACHY
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 N WOODLAND BLVD UNIT 8284
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32723-8417
Mailing Address - Country:US
Mailing Address - Phone:386-822-7029
Mailing Address - Fax:
Practice Address - Street 1:421 N WOODLAND BLVD UNIT 8284
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32723-8417
Practice Address - Country:US
Practice Address - Phone:386-822-7029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-22
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25682255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer