Provider Demographics
NPI:1003136094
Name:LOVE, ANETHIA CRISTAL (LMT)
Entity Type:Individual
Prefix:
First Name:ANETHIA
Middle Name:CRISTAL
Last Name:LOVE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 682983
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77268-2983
Mailing Address - Country:US
Mailing Address - Phone:832-651-8486
Mailing Address - Fax:
Practice Address - Street 1:7035 W TIDWELL RD BLDG J100A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77092-2054
Practice Address - Country:US
Practice Address - Phone:832-275-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-02
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT101345225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist