MEDICARE: TIESIA R 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
1	225700000X	Massage Therapist	73857	CA

General Provider Information

NPI Number	:	1639828353
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIESIA R LOVE

Provider Business Mailing Address
First Line	:	342 E EL PASO AVE UNIT 101
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93720-2430
Country	:	US
Telephone Number	:	559-521-5152
Fax Number	:

Provider Business Practice Location Address
First Line	:	4749 W SPRUCE AVE STE 107
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93722-3574
Country	:	US
Telephone Number	:	559-521-5152
Fax Number	:

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

Provider Enumeration Date	:	03/21/2022
Last Update Date	:	11/28/2022

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Directions to “ TIESIA R LOVE ” Practice Location

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