Healthcare Provider Details

I. General information

NPI: 1073195509
Provider Name (Legal Business Name): MARTHA LUCILA VERA HOVESTOL PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2021
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5667 JONES RD
OWENSBORO KY
42303-9559
US

IV. Provider business mailing address

5667 JONES RD
OWENSBORO KY
42303-9559
US

V. Phone/Fax

Practice location:
  • Phone: 209-531-6795
  • Fax: 209-531-6795
Mailing address:
  • Phone: 209-531-6795
  • Fax: 209-531-6795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number771
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT-005935
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: