Provider Demographics
NPI:1598092835
Name:STOVER, KYLE EDWARD (DPT)
Entity Type:Individual
Prefix:MR
First Name:KYLE
Middle Name:EDWARD
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 1:2 OVERHILL RD
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-5323
Mailing Address - Country:US
Mailing Address - Phone:914-723-6987
Mailing Address - Fax:914-723-7546
Practice Address - Street 1:2 OVERHILL RD
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-5323
Practice Address - Country:US
Practice Address - Phone:914-723-6987
Practice Address - Fax:914-723-7546
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-06
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030413225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist