Provider Demographics
NPI:1871705822
Name:KOVOOR, ELANGHOVAN V (RPT)
Entity type:Individual
Prefix:MR
First Name:ELANGHOVAN
Middle Name:V
Last Name:KOVOOR
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:GREEN
Other - Middle Name:
Other - Last Name:REHAB
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6481 RUTLEDGE PARK DR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-2458
Mailing Address - Country:US
Mailing Address - Phone:989-865-0406
Mailing Address - Fax:989-865-0406
Practice Address - Street 1:6481 RUTLEDGE PARK DR
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-2458
Practice Address - Country:US
Practice Address - Phone:989-865-0406
Practice Address - Fax:989-865-0406
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501004961225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist