Provider Demographics
NPI:1831537653
Name:OVARD, JAQUELINE M (DPT)
Entity type:Individual
Prefix:
First Name:JAQUELINE
Middle Name:M
Last Name:OVARD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JAQUELINE
Other - Middle Name:M
Other - Last Name:KVASNICKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:PO BOX 34120
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89533-4120
Mailing Address - Country:US
Mailing Address - Phone:775-747-5050
Mailing Address - Fax:775-747-5005
Practice Address - Street 1:1701 COUNTY ROAD
Practice Address - Street 2:SUITE B
Practice Address - City:MINDEN
Practice Address - State:NV
Practice Address - Zip Code:89423-4465
Practice Address - Country:US
Practice Address - Phone:775-782-4466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-14
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2829225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2829OtherSTATE LICENSE