Provider Demographics
NPI:1720098080
Name:LOVELL, ROBERT WARNER (MPT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:WARNER
Last Name:LOVELL
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 1:530 E OLYMPIA AVE
Mailing Address - Street 2:SUITE 112
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-3838
Mailing Address - Country:US
Mailing Address - Phone:941-575-7300
Mailing Address - Fax:941-505-7301
Practice Address - Street 1:530 E OLYMPIA AVE
Practice Address - Street 2:SUITE 112
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-3838
Practice Address - Country:US
Practice Address - Phone:941-575-7300
Practice Address - Fax:941-505-7301
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP7677225100000X
FLPT21425225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY053TZMedicare ID - Type UnspecifiedINDIVIDUAL MEDICARE #