Healthcare Provider Details

I. General information

NPI: 1073305090
Provider Name (Legal Business Name): ARISSA VANOVER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2025
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26901 US HIGHWAY 119 N
BELFRY KY
41514-7520
US

IV. Provider business mailing address

9978 HIGHWAY 119 N
JENKINS KY
41537-8990
US

V. Phone/Fax

Practice location:
  • Phone: 606-237-1460
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA04325
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: