Provider Demographics
NPI:1356676407
Name:MCLOUGHLIN, DEIRDRE (DPT)
Entity type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:
Last Name:MCLOUGHLIN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 ADDISON ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94702-1700
Mailing Address - Country:US
Mailing Address - Phone:510-883-1126
Mailing Address - Fax:510-883-9926
Practice Address - Street 1:1250 ADDISON ST
Practice Address - Street 2:SUITE 102
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94702-1700
Practice Address - Country:US
Practice Address - Phone:510-883-1126
Practice Address - Fax:510-883-9926
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-07
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT248512251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic