Provider Demographics
NPI:1821200023
Name:ROGER DE COVERLEY, IVA (PT,MA)
Entity Type:Individual
Prefix:MS
First Name:IVA
Middle Name:
Last Name:ROGER DE COVERLEY
Suffix:
Gender:F
Credentials:PT,MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 CROSS ST
Mailing Address - Street 2:
Mailing Address - City:LACONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03246-3317
Mailing Address - Country:US
Mailing Address - Phone:603-224-2699
Mailing Address - Fax:
Practice Address - Street 1:246 PLEASANT ST
Practice Address - Street 2:SUITE 104
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-2548
Practice Address - Country:US
Practice Address - Phone:603-224-2699
Practice Address - Fax:603-227-7041
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1528225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist