Healthcare Provider Details

I. General information

NPI: 1538087085
Provider Name (Legal Business Name): SHANEY STOVER PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1502 5TH AVE S
BIRMINGHAM AL
35233-1615
US

IV. Provider business mailing address

2545 ROCK SPRINGS RD
WARRIOR AL
35180-5719
US

V. Phone/Fax

Practice location:
  • Phone: 205-276-0308
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA7801
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: