Provider Demographics
NPI:1417360819
Name:LOVILL, KATRINA (LPTA)
Entity Type:Individual
Prefix:MS
First Name:KATRINA
Middle Name:
Last Name:LOVILL
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1716 BALLARD DR SE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-1619
Mailing Address - Country:US
Mailing Address - Phone:256-479-0955
Mailing Address - Fax:
Practice Address - Street 1:1716 BALLARD DR SE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-1619
Practice Address - Country:US
Practice Address - Phone:256-479-0955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTA1527314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility