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General NPI Number Information
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NPI Number | 1760357438
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Entity Type | Individual
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Provider Name | KELLI STOVER PTA
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Gender | Female
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Dates
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Enumeration Date | 10/10/2025
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Last Update Date | 10/10/2025
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Provider Practice Location Address
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Address Line | 2100 W TETON BLVD
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City | GREEN RIVER
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State | WY
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Zip | 82935-6040
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Country | US
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Telephone | 303-588-2838
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Fax |
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Provider Business Mailing Address
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Address Line | 14442 18TH ST NW
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City | ALEXANDER
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State | ND
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Zip | 58831-9595
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Country | US
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Telephone | 303-588-2838
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 1363A
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License Number State | ND
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