Provider Demographics
NPI:1811753247
Name:LOVELL, KENNETH RYAN (PT, DPT, NCS, ATP)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:RYAN
Last Name:LOVELL
Suffix:
Gender:M
Credentials:PT, DPT, NCS, ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3772 ALZADA RD
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-3802
Mailing Address - Country:US
Mailing Address - Phone:626-712-7164
Mailing Address - Fax:
Practice Address - Street 1:111 S HUDSON AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2606
Practice Address - Country:US
Practice Address - Phone:626-683-8536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-23
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42401261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy