Provider Demographics
NPI:1164969812
Name:BOVA, PAUL JOSEPH JR (PTA)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:JOSEPH
Last Name:BOVA
Suffix:JR
Gender:M
Credentials:PTA
Other - Prefix:MR
Other - First Name:PAUL
Other - Middle Name:J
Other - Last Name:BOVA
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:2265 MARKET ST
Mailing Address - Street 2:STE A
Mailing Address - City:WARREN
Mailing Address - State:PA
Mailing Address - Zip Code:16365-4682
Mailing Address - Country:US
Mailing Address - Phone:814-726-9050
Mailing Address - Fax:814-726-9629
Practice Address - Street 1:2265 MARKET ST
Practice Address - Street 2:STE A
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365-4682
Practice Address - Country:US
Practice Address - Phone:814-726-9050
Practice Address - Fax:814-726-9629
Is Sole Proprietor?:No
Enumeration Date:2017-01-19
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI001973225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant