Provider Demographics
NPI:1528011525
Name:STOVER, GRETCHEN (DPT)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:
Last Name:STOVER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 RECTOR ST
Mailing Address - Street 2:SUITE 1303
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10006-1819
Mailing Address - Country:US
Mailing Address - Phone:212-374-0181
Mailing Address - Fax:212-374-0457
Practice Address - Street 1:2 RECTOR ST
Practice Address - Street 2:SUITE 1303
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10006-1819
Practice Address - Country:US
Practice Address - Phone:212-374-0181
Practice Address - Fax:212-374-0457
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026546225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist