Provider Demographics
NPI:1104199348
Name:COVERT, REBECCA E (LMT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:E
Last Name:COVERT
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 1:3206 S HOPKINS AVE # 19
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780-5667
Mailing Address - Country:US
Mailing Address - Phone:321-757-6899
Mailing Address - Fax:321-757-6859
Practice Address - Street 1:3910 S WASHINGTON AVE STE 109
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780-5860
Practice Address - Country:US
Practice Address - Phone:321-267-0188
Practice Address - Fax:321-267-0611
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-20
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA56950174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist