Provider Demographics
NPI:1972753770
Name:LOOS, DANA (PTA)
Entity Type:Individual
Prefix:MS
First Name:DANA
Middle Name:
Last Name:LOOS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MS
Other - First Name:DANA
Other - Middle Name:
Other - Last Name:LOOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:8455 S SUNCOAST BLVD
Mailing Address - Street 2:
Mailing Address - City:HOMOSASSA
Mailing Address - State:FL
Mailing Address - Zip Code:34446-5066
Mailing Address - Country:US
Mailing Address - Phone:352-629-0033
Mailing Address - Fax:352-629-0072
Practice Address - Street 1:2685 SW 32ND PL STE 200
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-7864
Practice Address - Country:US
Practice Address - Phone:352-629-0033
Practice Address - Fax:352-629-0072
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-29
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZPTA21380225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106898OtherMEDICARE ID