Provider Demographics
NPI:1922311976
Name:LOOBY, JENNIFER MARIE (MS, PT , CLT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MARIE
Last Name:LOOBY
Suffix:
Gender:F
Credentials:MS, PT , CLT
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:MARIE
Other - Last Name:PURCELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS , PT CLT
Mailing Address - Street 1:485 BULLET HOLE RD
Mailing Address - Street 2:
Mailing Address - City:MAHOPAC
Mailing Address - State:NY
Mailing Address - Zip Code:10541-2608
Mailing Address - Country:US
Mailing Address - Phone:845-519-6169
Mailing Address - Fax:
Practice Address - Street 1:485 BULLET HOLE RD
Practice Address - Street 2:
Practice Address - City:MAHOPAC
Practice Address - State:NY
Practice Address - Zip Code:10541-2608
Practice Address - Country:US
Practice Address - Phone:845-519-6169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-20
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025898-1172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist