Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 1351187 | TX |
N | 225100000X | Physical Therapist | 3126891 | TX |
N | 2251S0007X | Physical Therapist - Sports | 1351187 | TX |
NPI | 1457929994 |
---|---|
Provider Name | Dr. John Love |
First Address | Austin, TX 78758-4535 |
Second Address | Austin, TX 78758-4535 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2021 |
Last Update Date | 23/08/2021 |