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General NPI Number Information
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NPI Number | 1073195509
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Entity Type | Individual
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Provider Name | MARTHA LUCILA VERA HOVESTOL PT
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Gender | Female
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Dates
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Enumeration Date | 04/23/2021
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Last Update Date | 06/24/2025
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Provider Practice Location Address
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Address Line | 5667 JONES RD
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City | OWENSBORO
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State | KY
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Zip | 42303-9559
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Country | US
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Telephone | 209-531-6795
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Fax | 209-531-6795
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Provider Business Mailing Address
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Address Line | 5667 JONES RD
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City | OWENSBORO
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State | KY
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Zip | 42303-9559
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Country | US
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Telephone | 209-531-6795
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Fax | 209-531-6795
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 771
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License Number State | HI
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Taxonomy #2
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | PT-005935
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License Number State | KY
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