Provider Demographics
NPI:1619211455
Name:LOVE, SUSAN D (PT)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:D
Last Name:LOVE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 NE RICE RD
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-5540
Mailing Address - Country:US
Mailing Address - Phone:816-554-1518
Mailing Address - Fax:816-554-8710
Practice Address - Street 1:805 NE RICE RD
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-5540
Practice Address - Country:US
Practice Address - Phone:816-554-1518
Practice Address - Fax:816-554-8710
Is Sole Proprietor?:No
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR1249225100000X
KS11-01739225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist