Provider Demographics
NPI:1932667508
Name:LOYD, SAMUEL BRADLEY
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:BRADLEY
Last Name:LOYD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 FORGET ME NOT DR
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-8444
Mailing Address - Country:US
Mailing Address - Phone:717-733-2367
Mailing Address - Fax:
Practice Address - Street 1:904 DAWN AVE
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-1340
Practice Address - Country:US
Practice Address - Phone:717-738-2555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-03
Last Update Date:2019-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG010763225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist