Provider Demographics
NPI:1225892003
Name:LOAEZA, JORDI (LMT)
Entity Type:Individual
Prefix:
First Name:JORDI
Middle Name:
Last Name:LOAEZA
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 BARTON ST UNIT 661
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:VT
Mailing Address - Zip Code:05033-2027
Mailing Address - Country:US
Mailing Address - Phone:802-821-0902
Mailing Address - Fax:
Practice Address - Street 1:321 VT-113
Practice Address - Street 2:
Practice Address - City:THETFORD
Practice Address - State:VT
Practice Address - Zip Code:05043
Practice Address - Country:US
Practice Address - Phone:802-821-0902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT164.0001225225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist