Provider Demographics
NPI:1093801003
Name:LOZE, GEORGE WILLIAM (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:WILLIAM
Last Name:LOZE
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:WHITLEY CITY
Mailing Address - State:KY
Mailing Address - Zip Code:42653-0936
Mailing Address - Country:US
Mailing Address - Phone:606-376-8020
Mailing Address - Fax:606-376-8055
Practice Address - Street 1:551 N HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:WHITLEY CITY
Practice Address - State:KY
Practice Address - Zip Code:42653-4083
Practice Address - Country:US
Practice Address - Phone:606-376-8020
Practice Address - Fax:606-376-8055
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY000953225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000543321OtherANTHEM BC/BS
KY7100014340Medicaid
KY1185497OtherCHA PROVIDER NUMBER
KYP00422439OtherRAILROAD MEDICARE
KY000000543321OtherANTHEM BC/BS