MEDICARE: MRS. HANNAH LOVVORN PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	06005141A	IN

General Provider Information

NPI Number	:	1063966737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HANNAH LOVVORN PTA

Provider Business Mailing Address
First Line	:	PO BOX 5629
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47716-5629
Country	:	US
Telephone Number	:	812-759-3001
Fax Number	:	812-401-9013

Provider Business Practice Location Address
First Line	:	4421 N 1ST AVE
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47710-3621
Country	:	US
Telephone Number	:	812-759-3001
Fax Number	:	812-401-9013

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2016
Last Update Date	:	08/10/2016

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