Healthcare Provider Details

I. General information

NPI: 1164776746
Provider Name (Legal Business Name): CARLA MARIE HOVANES MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2012
Last Update Date: 11/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 INDIAN LAKE BLVD APT B308
HENDERSONVILLE TN
37075-6273
US

IV. Provider business mailing address

245 INDIAN LAKE BLVD APT B308
HENDERSONVILLE TN
37075-6273
US

V. Phone/Fax

Practice location:
  • Phone: 704-701-9154
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number9484
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: