Provider Demographics
NPI:1942276274
Name:STOVER, DON A III (PT)
Entity Type:Individual
Prefix:MR
First Name:DON
Middle Name:A
Last Name:STOVER
Suffix:III
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 890178
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73189-0178
Mailing Address - Country:US
Mailing Address - Phone:405-735-2270
Mailing Address - Fax:405-735-2273
Practice Address - Street 1:10400 S PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-6907
Practice Address - Country:US
Practice Address - Phone:405-735-2270
Practice Address - Fax:405-735-2273
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2017-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT2275225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK182988500OtherDOL
OK200116740AMedicaid
OK376599Medicare ID - Type Unspecified