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NPI Code Detail

MEDICARE: KELLY D KOVACIC PT

MEDICARE: KELLY D KOVACIC PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist09059OH

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
16500222996OTHEROHMEDICARE RAILROAD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2000000198483OTHEROHANTHEM
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1215918909
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY D KOVACIC PT
Provider Business Mailing Address
First Line : PO BOX 392573
Second Line :
City : PITTSBURGH
State : PA
Zip : 15251-4084
Country : US
Telephone Number : 724-343-4060
Fax Number :
Provider Business Practice Location Address
First Line : 17 E RIVER ST STE A
Second Line :
City : NEWTON FALLS
State : OH
Zip : 44444-1372
Country : US
Telephone Number : 330-872-7242
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/09/2005
Last Update Date : 10/07/2024

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Directions to “ KELLY D KOVACIC PT” Practice Location

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