Healthcare Provider Details

I. General information

NPI: 1104199348
Provider Name (Legal Business Name): REBECCA E COVERT LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2012
Last Update Date: 02/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3910 S WASHINGTON AVE STE 109
TITUSVILLE FL
32780-5860
US

IV. Provider business mailing address

3206 S HOPKINS AVE # 19
TITUSVILLE FL
32780-5667
US

V. Phone/Fax

Practice location:
  • Phone: 321-267-0188
  • Fax: 321-267-0611
Mailing address:
  • Phone: 321-757-6899
  • Fax: 321-757-6859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA56950
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: