Provider Demographics
NPI:1932507100
Name:LOVELESS, JASON (PT DPT)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:LOVELESS
Suffix:
Gender:M
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 PICO BLVD UNIT 102
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-1776
Mailing Address - Country:US
Mailing Address - Phone:310-728-5500
Mailing Address - Fax:
Practice Address - Street 1:2222 PICO BLVD UNIT 102
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-1776
Practice Address - Country:US
Practice Address - Phone:310-728-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-19
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41923225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist