Provider Demographics
NPI:1366445033
Name:HOVER, IAN (PT, MPT)
Entity Type:Individual
Prefix:MR
First Name:IAN
Middle Name:
Last Name:HOVER
Suffix:
Gender:M
Credentials:PT, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8240 W. CACTUS RD.
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381
Mailing Address - Country:US
Mailing Address - Phone:623-878-9696
Mailing Address - Fax:623-776-0668
Practice Address - Street 1:8240 W. CACTUS ROAD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381
Practice Address - Country:US
Practice Address - Phone:623-878-9696
Practice Address - Fax:623-776-0668
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6688225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ926157Medicaid
AZ110934Medicare PIN
AZ101960Medicare ID - Type Unspecified