Provider Demographics
NPI:1881022473
Name:KOVAR, KELLY
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:KOVAR
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 1:421 RAILROAD ST
Mailing Address - Street 2:TABER BUILDING, SUITE 206
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-3764
Mailing Address - Country:US
Mailing Address - Phone:330-221-0392
Mailing Address - Fax:
Practice Address - Street 1:421 RAILROAD ST
Practice Address - Street 2:TABER BUILDING, SUITE 206
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-3764
Practice Address - Country:US
Practice Address - Phone:775-753-7626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-17
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT.014428225100000X
NCP14518225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP14518OtherNORTH CAROLINA BOARD OF PHYSICAL THERAPY
OHPT.014428OtherOHIO STATE BOARD OF PHYSICAL THERAPY