Provider Demographics
NPI:1245540780
Name:STOVER, ELLEN MARGARET (PT)
Entity type:Individual
Prefix:MISS
First Name:ELLEN
Middle Name:MARGARET
Last Name:STOVER
Suffix:
Gender:F
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:P O BOX 381
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16354-0381
Mailing Address - Country:US
Mailing Address - Phone:814-827-2347
Mailing Address - Fax:814-827-2391
Practice Address - Street 1:202 UNION STREET
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16354
Practice Address - Country:US
Practice Address - Phone:814-827-2347
Practice Address - Fax:814-827-2391
Is Sole Proprietor?:No
Enumeration Date:2010-10-18
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT007565L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist