Healthcare Provider Details

I. General information

NPI: 1912812413
Provider Name (Legal Business Name): TIFFANY MICHELLE KOVASH PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 RESEARCH CT STE 450
SUWANEE GA
30024-6660
US

IV. Provider business mailing address

195 ARDEN PL
ALPHARETTA GA
30022-5218
US

V. Phone/Fax

Practice location:
  • Phone: 770-205-5551
  • Fax: 470-359-2982
Mailing address:
  • Phone: 225-316-7307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT018503
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: