MEDICARE: LUCAS ZACKERY 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	2251G0304X	Geriatric Physical Therapist

General Provider Information

NPI Number	:	1871051482
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUCAS ZACKERY LOVE

Provider Business Mailing Address
First Line	:	15814 TAMPKE PL
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78247-5914
Country	:	US
Telephone Number	:	325-277-6156
Fax Number	:

Provider Business Practice Location Address
First Line	:	15814 TAMPKE PL
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78247-5914
Country	:	US
Telephone Number	:	325-277-6156
Fax Number	:

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

Provider Enumeration Date	:	03/04/2019
Last Update Date	:	03/04/2019

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Directions to “ LUCAS ZACKERY LOVE ” Practice Location

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