Provider Demographics
NPI:1689253445
Name:STOVER, HANNAH G (LMT)
Entity Type:Individual
Prefix:MISS
First Name:HANNAH
Middle Name:G
Last Name:STOVER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 BROOKHAVEN LN
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:NY
Mailing Address - Zip Code:14086-9568
Mailing Address - Country:US
Mailing Address - Phone:716-812-2203
Mailing Address - Fax:
Practice Address - Street 1:1201 COLVIN BLVD STE 2A
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14223-1936
Practice Address - Country:US
Practice Address - Phone:716-812-2203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032522-01225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist