Provider Demographics
NPI:1518252089
Name:LOOSE, BRANT DAVID (DPT)
Entity Type:Individual
Prefix:
First Name:BRANT
Middle Name:DAVID
Last Name:LOOSE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7399 W 97TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-2210
Mailing Address - Country:US
Mailing Address - Phone:913-649-9090
Mailing Address - Fax:913-649-9091
Practice Address - Street 1:7399 W 97TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-2210
Practice Address - Country:US
Practice Address - Phone:913-649-9090
Practice Address - Fax:913-649-9091
Is Sole Proprietor?:No
Enumeration Date:2011-06-13
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-04252225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist