Provider Demographics
NPI:1639397433
Name:DEVINNEY, LOREN (PT)
Entity Type:Individual
Prefix:MR
First Name:LOREN
Middle Name:
Last Name:DEVINNEY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6020 W MAPLE RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-4409
Mailing Address - Country:US
Mailing Address - Phone:248-851-6999
Mailing Address - Fax:248-851-6898
Practice Address - Street 1:6020 W MAPLE RD
Practice Address - Street 2:SUITE 500
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-4409
Practice Address - Country:US
Practice Address - Phone:248-851-6999
Practice Address - Fax:248-851-6898
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501002485225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist