Provider Demographics
NPI:1598158362
Name:LOVELAND-GRACE, TIERNEY MARIE (DPT)
Entity Type:Individual
Prefix:
First Name:TIERNEY
Middle Name:MARIE
Last Name:LOVELAND-GRACE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:TIERNEY
Other - Middle Name:
Other - Last Name:LOVELAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10262 LA HACIENDA AVE
Mailing Address - Street 2:APT C-12
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-3630
Mailing Address - Country:US
Mailing Address - Phone:414-687-1719
Mailing Address - Fax:
Practice Address - Street 1:10262 LA HACIENDA AVE
Practice Address - Street 2:APT C-12
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-3630
Practice Address - Country:US
Practice Address - Phone:414-687-1719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-18
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39102225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist