MEDICARE: MR. DON A STOVER III PT

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	182988500	OTHER	OK	DOL
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942276274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DON A STOVER III PT

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2006
Last Update Date	:	10/13/2017

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