Provider Demographics
NPI:1972556629
Name:COVENANT HAND THERAPY PC
Entity Type:Organization
Organization Name:COVENANT HAND THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:BLOM
Authorized Official - Suffix:
Authorized Official - Credentials:MA OTR CHT
Authorized Official - Phone:972-599-9594
Mailing Address - Street 1:1101 OHIO DR
Mailing Address - Street 2:STE 105
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093
Mailing Address - Country:US
Mailing Address - Phone:972-599-9594
Mailing Address - Fax:972-599-9364
Practice Address - Street 1:1101 OHIO DR
Practice Address - Street 2:STE 105
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093
Practice Address - Country:US
Practice Address - Phone:972-599-9594
Practice Address - Fax:972-599-9364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX335E00000X, 225100000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered335E00000XSuppliersProsthetic/Orthotic Supplier
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4724960001OtherPALMETTO GBA DMERC
TX0055JCOtherBLUE CROSS BLUE SHIELD
TX00493UMedicare ID - Type Unspecified