Provider Demographics
NPI:1932455342
Name:COVERT, JESSICA MORIAH (ATC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MORIAH
Last Name:COVERT
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:MORIAH
Other - Last Name:VANDERVEEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:3575 KEITH ST NW
Practice Address - Street 2:STE 205
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-4324
Practice Address - Country:US
Practice Address - Phone:423-559-0444
Practice Address - Fax:423-559-0103
Is Sole Proprietor?:No
Enumeration Date:2012-08-03
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0020932255A2300X
TN15502255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer