Provider Demographics
NPI:1487292686
Name:COVA, LORI (LMT)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:COVA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 NEW BRITAIN RD STE 101
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:CT
Mailing Address - Zip Code:06037-5305
Mailing Address - Country:US
Mailing Address - Phone:860-944-1166
Mailing Address - Fax:
Practice Address - Street 1:460 NEW BRITAIN RD STE 101
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:CT
Practice Address - Zip Code:06037-5305
Practice Address - Country:US
Practice Address - Phone:860-944-1166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-18
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007309225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty