Provider Demographics
NPI:1598806788
Name:LOEBSACK, ALICE RENEE (ATC, CSCS)
Entity Type:Individual
Prefix:MS
First Name:ALICE
Middle Name:RENEE
Last Name:LOEBSACK
Suffix:
Gender:F
Credentials:ATC, CSCS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5000 ABBEY WAY SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-3200
Mailing Address - Country:US
Mailing Address - Phone:253-363-0005
Mailing Address - Fax:
Practice Address - Street 1:5000 ABBEY WAY SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503
Practice Address - Country:US
Practice Address - Phone:360-438-4536
Practice Address - Fax:360-438-4568
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAA160095964OtherWA DEPARTMENT OF HEALTH LISCENSE