Provider Demographics
NPI:1710387253
Name:LOSS, JUSTIN RYAN (PT)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:RYAN
Last Name:LOSS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:630-759-9510
Practice Address - Street 1:205 SAGE RD
Practice Address - Street 2:STE 203
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-6995
Practice Address - Country:US
Practice Address - Phone:919-918-4171
Practice Address - Fax:919-918-4172
Is Sole Proprietor?:No
Enumeration Date:2014-09-03
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15149225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist