Provider Demographics
NPI:1881827376
Name:LOO, LESLIE ELLEN (LMP)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:ELLEN
Last Name:LOO
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 S PINE ST
Mailing Address - Street 2:201
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-2793
Mailing Address - Country:US
Mailing Address - Phone:253-396-1000
Mailing Address - Fax:253-396-1012
Practice Address - Street 1:601 S PINE ST
Practice Address - Street 2:201
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-2793
Practice Address - Country:US
Practice Address - Phone:253-396-1000
Practice Address - Fax:253-396-1012
Is Sole Proprietor?:No
Enumeration Date:2009-08-31
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist