Provider Demographics
NPI:1972646438
Name:LOVELL, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:LOVELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50095
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98145-5095
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:UW CAMPUS
Practice Address - Street 2:EAST STEVENS CIRCLE
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-4410
Practice Address - Country:US
Practice Address - Phone:206-616-2495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00000560225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
4125OtherINTERNAL ID-MOTOR VEHICLE ID
WA8346678Medicaid
AB20434Medicare ID - Type Unspecified
4125OtherINTERNAL ID-MOTOR VEHICLE ID