Provider Demographics
NPI:1881814184
Name:KOVALCIK, RENEE (PT)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:KOVALCIK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:
Other - Last Name:LEACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:5340 ROYALTON RD
Mailing Address - Street 2:
Mailing Address - City:NORTH ROYALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44133-4008
Mailing Address - Country:US
Mailing Address - Phone:440-230-1133
Mailing Address - Fax:440-230-9243
Practice Address - Street 1:1 INFINITY CORPORATE CENTRE DR
Practice Address - Street 2:SUITE 160
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44125-5369
Practice Address - Country:US
Practice Address - Phone:216-587-3310
Practice Address - Fax:216-518-2968
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH013161225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist