Provider Demographics
NPI:1770754103
Name:LOVAAS, KEITH ALLEN (PTA)
Entity type:Individual
Prefix:MR
First Name:KEITH
Middle Name:ALLEN
Last Name:LOVAAS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1000 LOVELL AVE W
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-4419
Mailing Address - Country:US
Mailing Address - Phone:651-484-3378
Mailing Address - Fax:651-484-8982
Practice Address - Street 1:1000 LOVELL AVE W
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-4419
Practice Address - Country:US
Practice Address - Phone:651-484-3378
Practice Address - Fax:651-484-8982
Is Sole Proprietor?:No
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant