Provider Demographics
NPI:1629291729
Name:LOVIO, MARTHA LYNN-DERY (RPT)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:LYNN-DERY
Last Name:LOVIO
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31151 PLYMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-2103
Mailing Address - Country:US
Mailing Address - Phone:734-422-8600
Mailing Address - Fax:734-422-8783
Practice Address - Street 1:31151 PLYMOUTH RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-2103
Practice Address - Country:US
Practice Address - Phone:734-422-8600
Practice Address - Fax:734-422-8783
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501002587225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN94340006Medicare PIN