Provider Demographics
NPI:1275624793
Name:LOVELAND, GARN (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:GARN
Middle Name:
Last Name:LOVELAND
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3319 N UNIVERSITY AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-4447
Mailing Address - Country:US
Mailing Address - Phone:503-799-6743
Mailing Address - Fax:801-788-4842
Practice Address - Street 1:1750 N WYMOUNT TERRACE DR
Practice Address - Street 2:2300 SHC
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84602
Practice Address - Country:US
Practice Address - Phone:801-356-0014
Practice Address - Fax:801-788-4842
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3443225100000X
UT277510-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR181519OtherOMAP