Provider Demographics
NPI:1457525487
Name:SOVA, KRISTINE MARIE (PT)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:MARIE
Last Name:SOVA
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 1:10368 S MONARDY LN
Mailing Address - Street 2:
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-6634
Mailing Address - Country:US
Mailing Address - Phone:414-207-1100
Mailing Address - Fax:
Practice Address - Street 1:1100 COMMERCE DR
Practice Address - Street 2:SUITE 114
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53406-3700
Practice Address - Country:US
Practice Address - Phone:262-886-3431
Practice Address - Fax:262-886-3954
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10707-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI10707-024OtherSTATE PHYSICAL THERAPY LISCENCE