Provider Demographics
NPI:1144349606
Name:LOEFFLER, BRIAN (PT)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:LOEFFLER
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 1:1 MAIN ST STE 102A
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-5259
Mailing Address - Country:US
Mailing Address - Phone:802-865-2226
Mailing Address - Fax:802-865-9981
Practice Address - Street 1:1 MAIN ST STE 102A
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-5259
Practice Address - Country:US
Practice Address - Phone:802-865-2226
Practice Address - Fax:802-865-9981
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040-0003419225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT5468101OtherVMC
VT58241OtherBLUE CROSS BLUE SHIELD
VT2677334-001OtherCIGNA
VT58241OtherBLUE CROSS BLUE SHIELD