Provider Demographics
NPI:1699915983
Name:KOVACS, MARY ANN (LMT)
Entity type:Individual
Prefix:
First Name:MARY ANN
Middle Name:
Last Name:KOVACS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1393
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57709
Mailing Address - Country:US
Mailing Address - Phone:605-348-2357
Mailing Address - Fax:
Practice Address - Street 1:4475 SW SCHOLLS FERRY RD
Practice Address - Street 2:STE 201
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-1955
Practice Address - Country:US
Practice Address - Phone:503-246-2350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12771225700000X
SDR057393163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist