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General NPI Number Information
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NPI Number | 1326475385
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Entity Type | Individual
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Provider Name | MR. BRYAN WAYNE LOVE
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Gender | Male
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Dates
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Enumeration Date | 10/04/2013
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Last Update Date | 10/04/2013
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Provider Practice Location Address
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Address Line | 9050 58TH DR E SUITE #101
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City | LAKEWOOD RANCH
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State | FL
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Zip | 34202-6104
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Country | US
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Telephone | 941-807-5240
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Fax |
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Provider Business Mailing Address
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Address Line | 5429 CARSO TER
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City | NORTH PORT
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State | FL
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Zip | 34286-6428
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Country | US
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Telephone | 941-429-6453
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA30231
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License Number State | FL
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