Provider Demographics
NPI:1477601714
Name:LOVE, JULIE D (PT)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:D
Last Name:LOVE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:12410 CANTRELL RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223
Mailing Address - Country:US
Mailing Address - Phone:501-224-1418
Mailing Address - Fax:501-224-1917
Practice Address - Street 1:12410 CANTRELL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223
Practice Address - Country:US
Practice Address - Phone:501-224-1418
Practice Address - Fax:501-224-1917
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AR1753225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR137695721Medicaid
AR5U498OtherBCBS