Provider Demographics
NPI:1255316733
Name:LOOMIS, CARRIE ANN (PT, MPT)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:ANN
Last Name:LOOMIS
Suffix:
Gender:F
Credentials:PT, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 ALI WAY
Mailing Address - Street 2:
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-3900
Mailing Address - Country:US
Mailing Address - Phone:760-535-9815
Mailing Address - Fax:
Practice Address - Street 1:1630 RIDGEWAY ST
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-5637
Practice Address - Country:US
Practice Address - Phone:760-688-9089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT24870225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP01453018OtherRR MEDICARE
CA0PT248700OtherBLUE SHIELD
CACA105901Medicare PIN
CA0PT248700OtherBLUE SHIELD