Provider Demographics
NPI:1104601921
Name:LOVING LIFE PHYSICAL THERAPY AND WELLNESS, INC.
Entity type:Organization
Organization Name:LOVING LIFE PHYSICAL THERAPY AND WELLNESS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:AISHA
Authorized Official - Middle Name:LEDA
Authorized Official - Last Name:WALLS
Authorized Official - Suffix:
Authorized Official - Credentials:DOCTORATE
Authorized Official - Phone:818-621-1145
Mailing Address - Street 1:1420 MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-3670
Mailing Address - Country:US
Mailing Address - Phone:818-621-1145
Mailing Address - Fax:
Practice Address - Street 1:1420 MEADOW DR
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-3670
Practice Address - Country:US
Practice Address - Phone:818-621-1145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty