Provider Demographics
NPI:1932114717
Name:KOVAL, AMANDA J (MSPT, CSCS)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:J
Last Name:KOVAL
Suffix:
Gender:F
Credentials:MSPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 E. DESERT INN RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121
Mailing Address - Country:US
Mailing Address - Phone:702-892-9077
Mailing Address - Fax:702-892-9044
Practice Address - Street 1:2800 E. DESERT INN RD
Practice Address - Street 2:SUITE 200
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121
Practice Address - Country:US
Practice Address - Phone:702-892-9077
Practice Address - Fax:702-892-9044
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1998225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV106009Medicare PIN