Provider Demographics
NPI:1518309491
Name:COVINGTON, D ELIZABETH (LMT, NCTMB)
Entity Type:Individual
Prefix:
First Name:D
Middle Name:ELIZABETH
Last Name:COVINGTON
Suffix:
Gender:F
Credentials:LMT, NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 SPENCER ST
Mailing Address - Street 2:
Mailing Address - City:BETHALTO
Mailing Address - State:IL
Mailing Address - Zip Code:62010-1762
Mailing Address - Country:US
Mailing Address - Phone:618-550-8792
Mailing Address - Fax:
Practice Address - Street 1:436 SPENCER ST
Practice Address - Street 2:
Practice Address - City:BETHALTO
Practice Address - State:IL
Practice Address - Zip Code:62010-1762
Practice Address - Country:US
Practice Address - Phone:618-550-8792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.015364225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist