Provider Demographics
NPI:1164793147
Name:LOVE, TONYA DANETTE (CRT)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:DANETTE
Last Name:LOVE
Suffix:
Gender:F
Credentials:CRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2255 UPPER AFTON RD E
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55119-4645
Mailing Address - Country:US
Mailing Address - Phone:651-338-2269
Mailing Address - Fax:
Practice Address - Street 1:2255 UPPER AFTON RD E
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55119-4645
Practice Address - Country:US
Practice Address - Phone:651-338-2269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2744227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified