MEDICARE: SCOTT KOVER NCMT, LDT

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
1	172M00000X	Mechanotherapist	R00260	MD

General Provider Information

NPI Number	:	1841449097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT KOVER NCMT, LDT

Provider Business Mailing Address
First Line	:	PO BOX 3612
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21214-0612
Country	:	US
Telephone Number	:	410-707-6290
Fax Number	:	410-426-4890

Provider Business Practice Location Address
First Line	:	1001 CROMWELL BRIDGE RD
Second Line	:	SUITE 208
City	:	TOWSON
State	:	MD
Zip	:	21286-3300
Country	:	US
Telephone Number	:	410-707-6290
Fax Number	:	410-426-4890

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2008
Last Update Date	:	09/11/2008

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