Provider Demographics
NPI:1770716219
Name:VANOVER, STEVEN ROY (PTA)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:ROY
Last Name:VANOVER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:388 VANOVER RD W
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40744-8978
Mailing Address - Country:US
Mailing Address - Phone:606-599-7936
Mailing Address - Fax:606-864-2797
Practice Address - Street 1:388 VANOVER RD W
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40744-8978
Practice Address - Country:US
Practice Address - Phone:606-599-7936
Practice Address - Fax:606-864-2797
Is Sole Proprietor?:No
Enumeration Date:2009-09-01
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA01560225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant