Provider Demographics
NPI:1336423748
Name:LOOS, ASHLEY ELIZABETH (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:ELIZABETH
Last Name:LOOS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50021-2007
Mailing Address - Country:US
Mailing Address - Phone:515-965-5311
Mailing Address - Fax:515-965-5301
Practice Address - Street 1:710 E 1ST ST
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50021-2007
Practice Address - Country:US
Practice Address - Phone:515-965-5311
Practice Address - Fax:515-965-5301
Is Sole Proprietor?:No
Enumeration Date:2011-10-04
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070018784225100000X
IA072262225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI19172070Medicare PIN
IAI19172Medicare PIN