Provider Demographics
NPI:1033737176
Name:LOYA, SANDRA DOLORES
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:DOLORES
Last Name:LOYA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4110 RIVERS RUN DR
Mailing Address - Street 2:
Mailing Address - City:LEWIS CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43035-8775
Mailing Address - Country:US
Mailing Address - Phone:937-875-0422
Mailing Address - Fax:
Practice Address - Street 1:4110 RIVERS RUN DR
Practice Address - Street 2:
Practice Address - City:LEWIS CENTER
Practice Address - State:OH
Practice Address - Zip Code:43035-8775
Practice Address - Country:US
Practice Address - Phone:937-875-0422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-06
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.018016225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist