Provider Demographics
NPI:1760442552
Name:LOOPER, MARK L (PT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:L
Last Name:LOOPER
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 1:790 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:
Practice Address - Street 1:11800 NE 128TH STREET
Practice Address - Street 2:SUITE 400
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-7299
Practice Address - Country:US
Practice Address - Phone:425-820-0869
Practice Address - Fax:425-820-1745
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2015-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00005113225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB09566Medicare PIN
WAG8905373Medicare UPIN