Provider Demographics
NPI:1609480524
Name:LOOMIS, EMILY BETH (LAC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:BETH
Last Name:LOOMIS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-2007
Mailing Address - Country:US
Mailing Address - Phone:267-872-6979
Mailing Address - Fax:
Practice Address - Street 1:206 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-2007
Practice Address - Country:US
Practice Address - Phone:267-872-6979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-08
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK001335171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist