Healthcare Provider Details

I. General information

NPI: 1225286461
Provider Name (Legal Business Name): KIMBERLY LOVELAND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2008
Last Update Date: 08/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

917 BEVILLE RD SUITE G
SOUTH DAYTONA FL
32119-1712
US

IV. Provider business mailing address

4 GREENBRIAR CT
MULLICA HILL NJ
08062-4634
US

V. Phone/Fax

Practice location:
  • Phone: 386-756-4395
  • Fax: 866-426-2811
Mailing address:
  • Phone: 610-368-3833
  • Fax: 866-426-2811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberTE004076L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: