Provider Demographics
NPI:1598993578
Name:LOONEY, GARY STEVE (MT007903)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:STEVE
Last Name:LOONEY
Suffix:
Gender:M
Credentials:MT007903
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5358 W VICKERY BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-7520
Mailing Address - Country:US
Mailing Address - Phone:817-731-6276
Mailing Address - Fax:817-731-5890
Practice Address - Street 1:5358 W VICKERY BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-7520
Practice Address - Country:US
Practice Address - Phone:817-731-6276
Practice Address - Fax:817-731-5890
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-29
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT007903172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist