Healthcare Provider Details

I. General information

NPI: 1386796548
Provider Name (Legal Business Name): STOVER PHYSICAL THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 10/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10400 S PENNSYLVANIA AVE
OKLAHOMA CITY OK
73159-6907
US

IV. Provider business mailing address

PO BOX 890178
OKLAHOMA CITY OK
73189-0178
US

V. Phone/Fax

Practice location:
  • Phone: 405-735-2270
  • Fax: 405-735-2273
Mailing address:
  • Phone: 405-735-2270
  • Fax: 405-735-2273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT2275
License Number StateOK

VIII. Authorized Official

Name: DON A STOVER III
Title or Position: OWNER
Credential:
Phone: 405-735-2270