Provider Demographics
NPI:1588054639
Name:KINGSBURY, LOVE (CMT)
Entity type:Individual
Prefix:MS
First Name:LOVE
Middle Name:
Last Name:KINGSBURY
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10275 BENT MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:BENT MOUNTAIN
Mailing Address - State:VA
Mailing Address - Zip Code:24059-2109
Mailing Address - Country:US
Mailing Address - Phone:540-400-0004
Mailing Address - Fax:
Practice Address - Street 1:2105 ELECTRIC RD
Practice Address - Street 2:SUITE 103
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-2315
Practice Address - Country:US
Practice Address - Phone:540-400-0004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-28
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019012259225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist