Provider Demographics
NPI:1396398202
Name:GOVONI, MIKE ELLIOT (RRT)
Entity type:Individual
Prefix:
First Name:MIKE
Middle Name:ELLIOT
Last Name:GOVONI
Suffix:
Gender:M
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 SE MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:MA
Mailing Address - Zip Code:01516-2445
Mailing Address - Country:US
Mailing Address - Phone:413-426-7571
Mailing Address - Fax:
Practice Address - Street 1:106 SE MAIN ST
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:MA
Practice Address - Zip Code:01516-2445
Practice Address - Country:US
Practice Address - Phone:413-426-7571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-19
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA29702279H0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279H0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredHome Health