Provider Demographics
NPI:1285236299
Name:COVINGTON, SAMANTHA (DPT)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:COVINGTON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 601
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:CA
Mailing Address - Zip Code:95625-0601
Mailing Address - Country:US
Mailing Address - Phone:707-624-5636
Mailing Address - Fax:
Practice Address - Street 1:5313 ELMIRA RD.
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:CA
Practice Address - Zip Code:95625-9562
Practice Address - Country:US
Practice Address - Phone:707-624-5636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-13
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA298439225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist