Provider Demographics
NPI:1386848257
Name:LOOSBROCK, TAMMY K (DPT, MBA)
Entity Type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:K
Last Name:LOOSBROCK
Suffix:
Gender:F
Credentials:DPT, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MN
Mailing Address - Zip Code:56110-1129
Mailing Address - Country:US
Mailing Address - Phone:507-483-2894
Mailing Address - Fax:
Practice Address - Street 1:1600 N KNISS AVE
Practice Address - Street 2:
Practice Address - City:LUVERNE
Practice Address - State:MN
Practice Address - Zip Code:56156
Practice Address - Country:US
Practice Address - Phone:507-449-1238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5844225100000X
IA03840225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist