Healthcare Provider Details

I. General information

NPI: 1255439758
Provider Name (Legal Business Name): MARSHA F LOVETT PT, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11301 WILSHIRE BLVD PT DEPT - W117
LOS ANGELES CA
90073-1003
US

IV. Provider business mailing address

1252 11TH ST APT 103
SANTA MONICA CA
90401-2014
US

V. Phone/Fax

Practice location:
  • Phone: 310-478-3711
  • Fax: 310-268-4935
Mailing address:
  • Phone: 310-478-3711
  • Fax: 310-268-4935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 1605
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: