Provider Demographics
NPI:1710179668
Name:LOEFFLER, CARRIE B (PT)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:B
Last Name:LOEFFLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13327 VITIANO CT
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-8874
Mailing Address - Country:US
Mailing Address - Phone:260-484-0980
Mailing Address - Fax:260-484-3696
Practice Address - Street 1:13327 VITIANO CT
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-8874
Practice Address - Country:US
Practice Address - Phone:260-484-0980
Practice Address - Fax:260-484-3696
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05005694A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist