Basic Information
| Provider Information | |||||||||
| NPI: | 1437675642 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOVEST | ||||||||
| FirstName: | STACI | ||||||||
| MiddleName: | SUE | ||||||||
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| Credential: | PHYSICAL THERAPIST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 165 BREMAN DR | ||||||||
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| City: | OTTAWA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458758431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6143528498 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2535 FORT AMANDA RD | ||||||||
| Address2: | |||||||||
| City: | LIMA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458043728 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4199992055 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2017 | ||||||||
| LastUpdateDate: | 08/18/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 9406 | OH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.