Provider Demographics
NPI:1053480608
Name:LOREN, MICHAEL D (PT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:LOREN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14116 MAGNOLIA BLVD
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-1119
Mailing Address - Country:US
Mailing Address - Phone:818-789-3819
Mailing Address - Fax:
Practice Address - Street 1:14116 MAGNOLIA BLVD
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-1119
Practice Address - Country:US
Practice Address - Phone:818-789-3819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33217225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT33217BMedicare PIN
CAWPT33217AMedicare PIN
CAWPT33217CMedicare PIN