Provider Demographics
NPI:1437437894
Name:LOEFFLER, CARLA MARIE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:MARIE
Last Name:LOEFFLER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:MARIE
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:N10561 GRANDVIEW LN
Mailing Address - Street 2:PHYSICAL THERAPY/REHAB DEPARTMENT
Mailing Address - City:IRONWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49938-9622
Mailing Address - Country:US
Mailing Address - Phone:906-932-5990
Mailing Address - Fax:
Practice Address - Street 1:N10561 GRANDVIEW LN
Practice Address - Street 2:PHYSICAL THERAPY/REHAB DEPARTMENT
Practice Address - City:IRONWOOD
Practice Address - State:MI
Practice Address - Zip Code:49938-9622
Practice Address - Country:US
Practice Address - Phone:906-932-2525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-02
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11835-24225100000X
MI5501015677225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI11835-24OtherPHYSICAL THERAPY LICENSE NUMBER
MI5501015677OtherPHYSICAL THERAPY LICENSE ID NUMBER