Provider Demographics
NPI:1225773930
Name:LORETH, GAIL ANN (PTA)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:ANN
Last Name:LORETH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:GAIL
Other - Middle Name:
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:563 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:OR
Mailing Address - Zip Code:97452-9727
Mailing Address - Country:US
Mailing Address - Phone:941-356-7080
Mailing Address - Fax:
Practice Address - Street 1:1735 ADKINS ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-5003
Practice Address - Country:US
Practice Address - Phone:541-683-5032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA-19954225200000X
OR9741225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty