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NPI Code Detail

MEDICARE: MR. BRYAN WAYNE LOVE

MEDICARE: MR. BRYAN WAYNE LOVE
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
1225700000XMassage TherapistMA30231FL

General Provider Information

NPI Number : 1326475385
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BRYAN WAYNE LOVE
Provider Business Mailing Address
First Line : 5429 CARSO TER
Second Line :
City : NORTH PORT
State : FL
Zip : 34286-6428
Country : US
Telephone Number : 941-429-6453
Fax Number :
Provider Business Practice Location Address
First Line : 9050 58TH DR E
Second Line : SUITE #101
City : LAKEWOOD RANCH
State : FL
Zip : 34202-6104
Country : US
Telephone Number : 941-807-5240
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2013
Last Update Date : 10/04/2013

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Directions to “ MR. BRYAN WAYNE LOVE ” Practice Location

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