Healthcare Provider Details

I. General information

NPI: 1598771339
Provider Name (Legal Business Name): KOVACEK PETERSON MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 08/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 KINGSLEY CT
FRANKENMUTH MI
48734-1270
US

IV. Provider business mailing address

12 KINGSLEY CT
FRANKENMUTH MI
48734-1270
US

V. Phone/Fax

Practice location:
  • Phone: 989-793-2856
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201000937
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501009515
License Number StateMI

VIII. Authorized Official

Name: PETER KOVACEK
Title or Position: PHYSICAL THERAPIST
Credential:
Phone: 586-774-5774