Provider Demographics
NPI:1548727225
Name:LOVELACE, KILEY MICHELLE (LAT, ATC)
Entity type:Individual
Prefix:
First Name:KILEY
Middle Name:MICHELLE
Last Name:LOVELACE
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6623 ROCKLAND DR
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:VA
Mailing Address - Zip Code:20124-2501
Mailing Address - Country:US
Mailing Address - Phone:804-874-9629
Mailing Address - Fax:
Practice Address - Street 1:6623 ROCKLAND DR
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:VA
Practice Address - Zip Code:20124-2501
Practice Address - Country:US
Practice Address - Phone:804-874-9629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-28
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN20000399682255A2300X
2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer