Provider Demographics
NPI:1386796548
Name:STOVER PHYSICAL THERAPY PC
Entity type:Organization
Organization Name:STOVER PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DON
Authorized Official - Middle Name:A
Authorized Official - Last Name:STOVER
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:405-735-2270
Mailing Address - Street 1:PO BOX 890178
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73189-0178
Mailing Address - Country:US
Mailing Address - Phone:405-735-2270
Mailing Address - Fax:405-735-2273
Practice Address - Street 1:10400 S PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-6907
Practice Address - Country:US
Practice Address - Phone:405-735-2270
Practice Address - Fax:405-735-2273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT2275225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200116740AMedicaid
1829788500OtherDEP OF LABOR