Provider Demographics
NPI:1437270089
Name:LOOMIS, STEPHEN ROBERT (PT)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:ROBERT
Last Name:LOOMIS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 HOKUM ROCK RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH DENNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02660-2357
Mailing Address - Country:US
Mailing Address - Phone:508-385-1900
Mailing Address - Fax:508-546-3050
Practice Address - Street 1:305 HOKUM ROCK RD
Practice Address - Street 2:
Practice Address - City:SOUTH DENNIS
Practice Address - State:MA
Practice Address - Zip Code:02660-2357
Practice Address - Country:US
Practice Address - Phone:508-385-1900
Practice Address - Fax:508-546-3050
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16764225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY69676Medicare PIN