Provider Demographics
NPI:1477917771
Name:STOVER, JOANNA SCHAFHAUSEN (MS, ATC)
Entity Type:Individual
Prefix:MRS
First Name:JOANNA
Middle Name:SCHAFHAUSEN
Last Name:STOVER
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:JOANNA
Other - Middle Name:
Other - Last Name:SCHAFHAUSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, ATC
Mailing Address - Street 1:1721 21ST ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-3916
Mailing Address - Country:US
Mailing Address - Phone:310-829-7391
Mailing Address - Fax:
Practice Address - Street 1:1721 21ST ST
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-3916
Practice Address - Country:US
Practice Address - Phone:310-829-7391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-12
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA060802156OtherBOARD OF CERTIFICATION