Provider Demographics
NPI:1104100742
Name:LOOMIS, SUSAN E (PT)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:E
Last Name:LOOMIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 GICK RD
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-8517
Mailing Address - Country:US
Mailing Address - Phone:518-746-3605
Mailing Address - Fax:518-746-3629
Practice Address - Street 1:61 QUAKER ST
Practice Address - Street 2:
Practice Address - City:GRANVILLE
Practice Address - State:NY
Practice Address - Zip Code:12832-1529
Practice Address - Country:US
Practice Address - Phone:518-642-9460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006100-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist