Provider Demographics
NPI:1073363099
Name:VAN LOO, JENA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JENA
Middle Name:
Last Name:VAN LOO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:JENA
Other - Middle Name:
Other - Last Name:NERLICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:413 N AVON ST
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-3533
Mailing Address - Country:US
Mailing Address - Phone:818-795-2017
Mailing Address - Fax:
Practice Address - Street 1:1500 SAN PABLO ST STE 2200
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-5313
Practice Address - Country:US
Practice Address - Phone:323-442-6050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA187682251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty