Provider Demographics
NPI:1154562445
Name:LOVE, DONNA LYNNE (PTA, CCI)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:LYNNE
Last Name:LOVE
Suffix:
Gender:F
Credentials:PTA, CCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1731 127TH PL SE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-6516
Mailing Address - Country:US
Mailing Address - Phone:425-218-1025
Mailing Address - Fax:
Practice Address - Street 1:1355 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-2022
Practice Address - Country:US
Practice Address - Phone:360-794-4011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP160069897225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant