Provider Demographics
NPI:1164760906
Name:LOOP, ELIZABETH N (LMP, LMT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:N
Last Name:LOOP
Suffix:
Gender:F
Credentials:LMP, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2814 E 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-2301
Mailing Address - Country:US
Mailing Address - Phone:503-679-2511
Mailing Address - Fax:
Practice Address - Street 1:2814 E 1ST AVE
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-2301
Practice Address - Country:US
Practice Address - Phone:503-679-2511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00010616225700000X
OR6267225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist