Provider Demographics
NPI:1477220556
Name:STOVER, NATHAN M (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:M
Last Name:STOVER
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 RANGER CIR
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:ME
Mailing Address - Zip Code:04530-4228
Mailing Address - Country:US
Mailing Address - Phone:207-522-5706
Mailing Address - Fax:
Practice Address - Street 1:333 GREEN END AVE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842-5620
Practice Address - Country:US
Practice Address - Phone:401-849-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-25
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT03465225100000X
NH4894225100000X
MA26131225100000X
MEPT6038225100000X
MN13225225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty