Provider Demographics
NPI:1962828699
Name:COVINGTON, EDWARD JR
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:COVINGTON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2851 N OAKLAND FOREST DR
Mailing Address - Street 2:APT 305
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33309-7659
Mailing Address - Country:US
Mailing Address - Phone:954-338-0487
Mailing Address - Fax:
Practice Address - Street 1:2851 N OAKLAND FOREST DR
Practice Address - Street 2:APT 305
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33309-7659
Practice Address - Country:US
Practice Address - Phone:954-338-0487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-05
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA59006225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist