Provider Demographics
NPI:1386205102
Name:LOOMIS, EVAN (DPT)
Entity Type:Individual
Prefix:DR
First Name:EVAN
Middle Name:
Last Name:LOOMIS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5001 W PAULINE WHITAKER PKWY STE 120
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-7341
Mailing Address - Country:US
Mailing Address - Phone:479-202-0337
Mailing Address - Fax:479-202-0338
Practice Address - Street 1:5001 W PAULINE WHITAKER PKWY STE 120
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-7341
Practice Address - Country:US
Practice Address - Phone:479-202-0337
Practice Address - Fax:479-202-0338
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5661225100000X
AR4625225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist