Provider Demographics
NPI:1336435486
Name:LOOSLI, MARISSA M (DPT)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:M
Last Name:LOOSLI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4950 NE BELKNAP CT
Mailing Address - Street 2:STE 107
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-5114
Mailing Address - Country:US
Mailing Address - Phone:360-835-5349
Mailing Address - Fax:360-835-5390
Practice Address - Street 1:1700 MAIN ST
Practice Address - Street 2:SUITE 222
Practice Address - City:WASHOUGAL
Practice Address - State:WA
Practice Address - Zip Code:98671-4126
Practice Address - Country:US
Practice Address - Phone:360-835-5349
Practice Address - Fax:360-835-5390
Is Sole Proprietor?:No
Enumeration Date:2011-06-27
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OR06574225100000X
WA60218867225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist