MEDICARE: RENEE KOVALCIK P.T.

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	225100000X	Physical Therapist	013161	OH

General Provider Information

NPI Number	:	1881814184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENEE KOVALCIK P.T.

Provider Business Mailing Address
First Line	:	5340 ROYALTON RD
Second Line	:
City	:	NORTH ROYALTON
State	:	OH
Zip	:	44133-4008
Country	:	US
Telephone Number	:	440-230-1133
Fax Number	:	440-230-9243

Provider Business Practice Location Address
First Line	:	1 INFINITY CORPORATE CENTRE DR
Second Line	:	SUITE 160
City	:	CLEVELAND
State	:	OH
Zip	:	44125-5369
Country	:	US
Telephone Number	:	216-587-3310
Fax Number	:	216-518-2968

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

Provider Enumeration Date	:	04/27/2007
Last Update Date	:	06/20/2011

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