Provider Demographics
NPI:1134616998
Name:LOVELESS, AMBER DAWN (AAS)
Entity type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:DAWN
Last Name:LOVELESS
Suffix:
Gender:F
Credentials:AAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 MARTIN DR W
Mailing Address - Street 2:
Mailing Address - City:WYNNE
Mailing Address - State:AR
Mailing Address - Zip Code:72396-3446
Mailing Address - Country:US
Mailing Address - Phone:870-362-0279
Mailing Address - Fax:
Practice Address - Street 1:319 MARTIN DR W
Practice Address - Street 2:
Practice Address - City:WYNNE
Practice Address - State:AR
Practice Address - Zip Code:72396-3446
Practice Address - Country:US
Practice Address - Phone:870-362-0279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA4168225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant