Provider Demographics
NPI:1720338882
Name:AKOVENKO, PATRICIA J (PT)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:J
Last Name:AKOVENKO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:PATTY
Other - Middle Name:
Other - Last Name:AKOVENKO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:220 W GOODWIN ST
Mailing Address - Street 2:STE 10-C
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86303-4794
Mailing Address - Country:US
Mailing Address - Phone:928-830-2611
Mailing Address - Fax:
Practice Address - Street 1:220 W GOODWIN ST
Practice Address - Street 2:STE 10-C
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86303-4794
Practice Address - Country:US
Practice Address - Phone:928-830-2611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8696225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist