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General NPI Number Information
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NPI Number | 1033585138
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Entity Type | Individual
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Provider Name | ETHAN COVALT
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Gender | Male
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Dates
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Enumeration Date | 08/12/2015
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Last Update Date | 08/12/2015
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Provider Practice Location Address
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Address Line | 403 6TH ST BOX 870
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City | HUNTINGDON
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State | PA
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Zip | 16652-1518
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Country | US
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Telephone | 877-312-6576
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Fax |
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Provider Business Mailing Address
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Address Line | 560 MAIN LINE DR
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City | LEWISTOWN
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State | PA
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Zip | 17044-8127
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Country | US
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Telephone | 717-462-0372
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | TEI004324
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License Number State | PA
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