Provider Demographics
NPI:1053507350
Name:LOOSBROCK, KATHLEEN MARIE (PTA)
Entity Type:Individual
Prefix:MISS
First Name:KATHLEEN
Middle Name:MARIE
Last Name:LOOSBROCK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:724 NEVADA AVE
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MN
Mailing Address - Zip Code:56110-1134
Mailing Address - Country:US
Mailing Address - Phone:507-483-2751
Mailing Address - Fax:
Practice Address - Street 1:1600 N KNISS AVE
Practice Address - Street 2:
Practice Address - City:LUVERNE
Practice Address - State:MN
Practice Address - Zip Code:56156
Practice Address - Country:US
Practice Address - Phone:507-449-1229
Practice Address - Fax:507-449-1336
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant