Provider Demographics
NPI:1770098022
Name:LOVE, JONNY R SR (CMT, CPNT)
Entity type:Individual
Prefix:MR
First Name:JONNY
Middle Name:R
Last Name:LOVE
Suffix:SR
Gender:M
Credentials:CMT, CPNT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15870 E UTAH PL
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80017-5029
Mailing Address - Country:US
Mailing Address - Phone:720-339-8795
Mailing Address - Fax:
Practice Address - Street 1:3955 E EXPOSITION AVE STE 200A
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-5032
Practice Address - Country:US
Practice Address - Phone:720-339-8795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-08
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist