Provider Demographics
NPI:1588936694
Name:LOVETT, ROSE SHEREE (PTA)
Entity type:Individual
Prefix:MISS
First Name:ROSE
Middle Name:SHEREE
Last Name:LOVETT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10200 BELLE RIVE BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-9057
Mailing Address - Country:US
Mailing Address - Phone:904-303-5982
Mailing Address - Fax:
Practice Address - Street 1:10200 BELLE RIVE BLVD
Practice Address - Street 2:#59
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-9057
Practice Address - Country:US
Practice Address - Phone:904-303-5982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-04
Last Update Date:2012-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA22484225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant