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NPI Code Detail

MEDICARE: MRS. DONNA LYNNE LOVE PTA, CCI

MEDICARE: MRS. DONNA LYNNE LOVE PTA, CCI
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
1225200000XPhysical Therapy AssistantP160069897WA

General Provider Information

NPI Number : 1154562445
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. DONNA LYNNE LOVE PTA, CCI
Provider Business Mailing Address
First Line : 1731 127TH PL SE
Second Line :
City : EVERETT
State : WA
Zip : 98208-6516
Country : US
Telephone Number : 425-218-1025
Fax Number :
Provider Business Practice Location Address
First Line : 1355 W MAIN ST
Second Line :
City : MONROE
State : WA
Zip : 98272-2022
Country : US
Telephone Number : 360-794-4011
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2009
Last Update Date : 07/21/2022

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