Provider Demographics
NPI:1093181950
Name:STOVER, BENJAMIN (DPT)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:STOVER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 N BUFFALO DR
Mailing Address - Street 2:SUITE #120
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-0310
Mailing Address - Country:US
Mailing Address - Phone:702-880-1515
Mailing Address - Fax:
Practice Address - Street 1:9005 S PECOS RD
Practice Address - Street 2:SUITE # 2520
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7190
Practice Address - Country:US
Practice Address - Phone:702-818-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-14
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3183225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist