Provider Demographics
NPI:1427299288
Name:KOVERMAN, JONATHON WILLIAM (MPT)
Entity type:Individual
Prefix:MR
First Name:JONATHON
Middle Name:WILLIAM
Last Name:KOVERMAN
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 CASE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-3703
Mailing Address - Country:US
Mailing Address - Phone:507-421-1770
Mailing Address - Fax:
Practice Address - Street 1:715 CASE AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-3703
Practice Address - Country:US
Practice Address - Phone:507-421-1770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-09
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7658225100000X
MI5501013584225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist