Provider Demographics
NPI:1215035324
Name:COVINGTON, GAYLE BENGTSON (PT)
Entity Type:Individual
Prefix:MRS
First Name:GAYLE
Middle Name:BENGTSON
Last Name:COVINGTON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:GAYLE
Other - Last Name:BENGTSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:8617 WILLOWICK DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-7533
Mailing Address - Country:US
Mailing Address - Phone:512-338-4941
Mailing Address - Fax:
Practice Address - Street 1:8617 WILLOWICK DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-7533
Practice Address - Country:US
Practice Address - Phone:512-338-4941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1024685225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1024685OtherSTATE BOARD
TX81970TOtherBCBS