Healthcare Provider Details

I. General information

NPI: 1033195243
Provider Name (Legal Business Name): LISA JEAN HOVER P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 POPE AVE MUNSON ARMY HEALTH CENTER (ATTN: MXCN-COD, MS. COTTON)
FORT LEAVENWORTH KS
66027-2332
US

IV. Provider business mailing address

1305 PLEASANT HILL DR
PLATTE CITY MO
64079-9686
US

V. Phone/Fax

Practice location:
  • Phone: 913-684-6562
  • Fax: 913-684-6208
Mailing address:
  • Phone: 816-431-6403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2005031076
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: