Provider Demographics
NPI:1306161708
Name:KOVALY, JOANN MARIE (LMT)
Entity type:Individual
Prefix:MRS
First Name:JOANN
Middle Name:MARIE
Last Name:KOVALY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MRS
Other - First Name:JOANN
Other - Middle Name:MARIE
Other - Last Name:HUBBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:21014 SE 268TH CT
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98042-6141
Mailing Address - Country:US
Mailing Address - Phone:253-740-9146
Mailing Address - Fax:
Practice Address - Street 1:21014 SE 268TH CT
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:WA
Practice Address - Zip Code:98042-6141
Practice Address - Country:US
Practice Address - Phone:253-740-9146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-30
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60132961225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist