Provider Demographics
NPI:1427268549
Name:VANOVER, SETH ADAM (PTA)
Entity type:Individual
Prefix:
First Name:SETH
Middle Name:ADAM
Last Name:VANOVER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8415 EL ARROYO DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-7012
Mailing Address - Country:US
Mailing Address - Phone:304-550-7755
Mailing Address - Fax:
Practice Address - Street 1:1408 N WEST SHORE BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-4525
Practice Address - Country:US
Practice Address - Phone:888-668-2761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6794225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant