Provider Demographics
NPI:1750632022
Name:STOVER, STEPHANIE LYNN
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LYNN
Last Name:STOVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:658 KENILWORTH DR
Mailing Address - Street 2:STE 100
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2312
Mailing Address - Country:US
Mailing Address - Phone:410-339-4600
Mailing Address - Fax:410-339-4601
Practice Address - Street 1:658 KENILWORTH DR
Practice Address - Street 2:STE 100
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2312
Practice Address - Country:US
Practice Address - Phone:410-339-4600
Practice Address - Fax:410-339-4601
Is Sole Proprietor?:No
Enumeration Date:2012-09-27
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305208417225100000X
MD24910225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist