Healthcare Provider Details

I. General information

NPI: 1477601714
Provider Name (Legal Business Name): JULIE D LOVE PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 06/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12410 CANTRELL RD SUITE 200
LITTLE ROCK AR
72223
US

IV. Provider business mailing address

12410 CANTRELL RD SUITE 200
LITTLE ROCK AR
72223
US

V. Phone/Fax

Practice location:
  • Phone: 501-224-1418
  • Fax: 501-224-1917
Mailing address:
  • Phone: 501-224-1418
  • Fax: 501-224-1917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1753
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number1753
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: