Provider Demographics
NPI:1356633101
Name:LOVELACE, CHRISTOPHER A (MPT)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:A
Last Name:LOVELACE
Suffix:
Gender:M
Credentials:MPT
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 10
Mailing Address - Street 2:
Mailing Address - City:CEDAR RIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:95924-0010
Mailing Address - Country:US
Mailing Address - Phone:530-478-1933
Mailing Address - Fax:530-478-1937
Practice Address - Street 1:569 SEARLS AVE
Practice Address - Street 2:
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-3063
Practice Address - Country:US
Practice Address - Phone:530-478-1933
Practice Address - Fax:530-478-1937
Is Sole Proprietor?:No
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT37641225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist