Provider Demographics
NPI:1508882515
Name:VANLOO, LIVIA M (MSPT)
Entity Type:Individual
Prefix:
First Name:LIVIA
Middle Name:M
Last Name:VANLOO
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:LIVIA
Other - Middle Name:M
Other - Last Name:BOYD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:1856 PROVIDENCE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701
Mailing Address - Country:US
Mailing Address - Phone:541-318-6278
Mailing Address - Fax:541-593-0316
Practice Address - Street 1:56881 ENTERPRISE DRIVE
Practice Address - Street 2:
Practice Address - City:SUNRIVER
Practice Address - State:OR
Practice Address - Zip Code:97707
Practice Address - Country:US
Practice Address - Phone:541-593-8535
Practice Address - Fax:541-593-0316
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4933225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
132439Medicare ID - Type Unspecified