Provider Demographics
NPI:1437675642
Name:HOVEST, STACI SUE (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:STACI
Middle Name:SUE
Last Name:HOVEST
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 BREMAN DR
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:OH
Mailing Address - Zip Code:45875-8431
Mailing Address - Country:US
Mailing Address - Phone:614-352-8498
Mailing Address - Fax:
Practice Address - Street 1:2535 FORT AMANDA RD
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804-3728
Practice Address - Country:US
Practice Address - Phone:419-999-2055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-18
Last Update Date:2017-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH9406225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist