Provider Demographics
NPI:1760445860
Name:LOOZE, SUSAN W (PT)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:W
Last Name:LOOZE
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:PO BOX 8019
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01102-8000
Mailing Address - Country:US
Mailing Address - Phone:866-431-4077
Mailing Address - Fax:413-774-7448
Practice Address - Street 1:31 HALL DR
Practice Address - Street 2:AMHERST MEDICAL CENTER
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-2751
Practice Address - Country:US
Practice Address - Phone:413-256-8561
Practice Address - Fax:413-256-4490
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2984225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA650020186OtherRAILROAD MEDICARE
MAY66347OtherBLUE CROSS BLUE SHIELD
MA736259OtherCONNECTICARE
MA0381802Medicaid
MA2329195OtherAETNA US/HEALTHCARE
MA470234OtherTUFTS HEALTH PLAN
MA24189OtherHEALTH NEW ENGLAND
MA626166OtherHARVARD PILGRIM HEALTHCAR
MAY68544Medicare PIN
MA24189OtherHEALTH NEW ENGLAND