Provider Demographics
NPI:1245332162
Name:KOVAR, MARILYN FRANCES (PT)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:FRANCES
Last Name:KOVAR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2965
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70404-2965
Mailing Address - Country:US
Mailing Address - Phone:985-542-7878
Mailing Address - Fax:985-542-4396
Practice Address - Street 1:2204 ROBIN AVE
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-5751
Practice Address - Country:US
Practice Address - Phone:985-542-7878
Practice Address - Fax:985-542-4396
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPT00137225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1677485Medicaid
LA691869OtherAETNA
LA691869OtherUNITED HEALTHCARE
LA1194646OtherCIGNA
LA721148536KOOtherHUMANA
LA1677485Medicaid