Provider Demographics
NPI:1952847766
Name:LOVETT, BRIANNA (PTA)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:
Last Name:LOVETT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11704 W CENTER RD STE 200
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-4327
Mailing Address - Country:US
Mailing Address - Phone:402-691-0500
Mailing Address - Fax:402-691-1586
Practice Address - Street 1:11704 W CENTER RD STE 200
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-4327
Practice Address - Country:US
Practice Address - Phone:402-691-0500
Practice Address - Fax:402-691-1586
Is Sole Proprietor?:No
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1541225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant