Provider Demographics
NPI:1295929206
Name:LOIACANO, JOSEPH (PTA)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:
Last Name:LOIACANO
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 TURFWAY PARK DR
Mailing Address - Street 2:
Mailing Address - City:ROBINSON
Mailing Address - State:TX
Mailing Address - Zip Code:76706-5679
Mailing Address - Country:US
Mailing Address - Phone:254-662-6474
Mailing Address - Fax:
Practice Address - Street 1:2620 CENTENARY BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-3356
Practice Address - Country:US
Practice Address - Phone:866-730-0707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-03
Last Update Date:2007-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2048800225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant