Provider Demographics
NPI:1437630316
Name:LOKEN, DAVID GREGORY (PT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:GREGORY
Last Name:LOKEN
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 1:2906 MERCY DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-6250
Mailing Address - Country:US
Mailing Address - Phone:815-222-2587
Mailing Address - Fax:
Practice Address - Street 1:1939 WILMINGTON DR UNIT 101
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-6104
Practice Address - Country:US
Practice Address - Phone:970-377-1422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0015734225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist