Provider Demographics
NPI:1851710172
Name:LOUCAKIS, LORALEI (LMT)
Entity Type:Individual
Prefix:
First Name:LORALEI
Middle Name:
Last Name:LOUCAKIS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:
Other - Last Name:LOUCAKIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:191 JEWEL BASIN CT STE 3C
Mailing Address - Street 2:
Mailing Address - City:BIGFORK
Mailing Address - State:MT
Mailing Address - Zip Code:59911-6294
Mailing Address - Country:US
Mailing Address - Phone:406-314-1809
Mailing Address - Fax:
Practice Address - Street 1:191 JEWEL BASIN CT STE 3C
Practice Address - Street 2:
Practice Address - City:BIGFORK
Practice Address - State:MT
Practice Address - Zip Code:59911-6294
Practice Address - Country:US
Practice Address - Phone:406-314-1809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-15
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1312225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist