Healthcare Provider Details

I. General information

NPI: 1366445033
Provider Name (Legal Business Name): IAN HOVER PT, MPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 11/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8240 W. CACTUS ROAD
PEORIA AZ
85381
US

IV. Provider business mailing address

8240 W. CACTUS RD.
PEORIA AZ
85381
US

V. Phone/Fax

Practice location:
  • Phone: 623-878-9696
  • Fax: 623-776-0668
Mailing address:
  • Phone: 623-878-9696
  • Fax: 623-776-0668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6688
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: