Provider Demographics
NPI:1043413008
Name:GOVONI, CAROL LYNNE (DPT)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:LYNNE
Last Name:GOVONI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:LYNNE
Other - Last Name:GRADY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:10405 MANLEY RD
Mailing Address - Street 2:
Mailing Address - City:NOKESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20181-1515
Mailing Address - Country:US
Mailing Address - Phone:703-862-9526
Mailing Address - Fax:
Practice Address - Street 1:6862 PIEDMONT CENTER PLZ
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-4034
Practice Address - Country:US
Practice Address - Phone:703-754-4690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305203871225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA196835OtherANTHEM
2130100OtherMAMSI
VA7841510OtherAETNA
VA7841510OtherAETNA