MEDICARE: ELAINA STOVER DPT

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	2251X0800X	Orthopedic Physical Therapist	30890	AZ

General Provider Information

NPI Number	:	1497303754
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELAINA STOVER DPT

Provider Business Mailing Address
First Line	:	863 N MUNROE RD
Second Line	:
City	:	TALLMADGE
State	:	OH
Zip	:	44278-1025
Country	:	US
Telephone Number	:	330-801-0734
Fax Number	:

Provider Business Practice Location Address
First Line	:	3601 W CORTARO FARMS RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85742-8645
Country	:	US
Telephone Number	:	520-325-4002
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2019
Last Update Date	:	08/29/2019

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