Healthcare Provider Details

I. General information

NPI: 1891574497
Provider Name (Legal Business Name): JANEL ELAINE LOVE PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 09/25/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 LIBERTY WAY
GAHANNA OH
43230-3502
US

IV. Provider business mailing address

11834 KENNINGTON SQ E
PICKERINGTON OH
43147-8561
US

V. Phone/Fax

Practice location:
  • Phone: 614-831-2600
  • Fax:
Mailing address:
  • Phone: 808-343-8303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA013668
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: