Provider Demographics
NPI:1982704805
Name:LOVING, MARK HAMMOND
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:HAMMOND
Last Name:LOVING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 SE MONTEREY RD
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-4410
Mailing Address - Country:US
Mailing Address - Phone:772-219-3313
Mailing Address - Fax:772-219-3314
Practice Address - Street 1:630 SE MONTEREY RD
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-4410
Practice Address - Country:US
Practice Address - Phone:772-219-3313
Practice Address - Fax:772-219-3314
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8004111N00000X
FLPT 5764225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP72685Medicare UPIN
FLE8474Medicare PIN
FLE8474YMedicare PIN
FLE8474ZMedicare PIN