Healthcare Provider Details

I. General information

NPI: 1932645249
Provider Name (Legal Business Name): SARA LOVSE ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2017
Last Update Date: 10/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 E REDWOOD ST
SPRINGFIELD MO
65807-5163
US

IV. Provider business mailing address

16490 DAWN DR
CLINTON TOWNSHIP MI
48038-1938
US

V. Phone/Fax

Practice location:
  • Phone: 586-764-6451
  • Fax:
Mailing address:
  • Phone: 586-764-6451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: