MEDICARE: STOVER PHYSICAL THERAPY PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT2275	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1829788500	OTHER		DEP OF LABOR

General Provider Information

NPI Number	:	1386796548
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STOVER PHYSICAL THERAPY PC

Provider Business Mailing Address
First Line	:	PO BOX 890178
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73189-0178
Country	:	US
Telephone Number	:	405-735-2270
Fax Number	:	405-735-2273

Provider Business Practice Location Address
First Line	:	10400 S PENNSYLVANIA AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73159-6907
Country	:	US
Telephone Number	:	405-735-2270
Fax Number	:	405-735-2273

Authorized Official
Title or Position	:	OWNER
Name	:	DON A STOVER III
Credential	:
Telephone Number	:	405-735-2270

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	10/30/2017

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Directions to “STOVER PHYSICAL THERAPY PC ” Practice Location

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