Healthcare Provider Details

I. General information

NPI: 1457929994
Provider Name (Legal Business Name): JOHN LOVE DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2021
Last Update Date: 08/23/2021
Certification Date: 08/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 DONLEY DR STE 106
AUSTIN TX
78758-4535
US

IV. Provider business mailing address

2305 DONLEY DR STE 106
AUSTIN TX
78758-4535
US

V. Phone/Fax

Practice location:
  • Phone: 512-266-1000
  • Fax: 512-597-0898
Mailing address:
  • Phone: 512-266-1000
  • Fax: 512-597-0898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number1351187
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1351187
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3126891
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: