Provider Demographics
NPI:1457412975
Name:LOOYENGA, WILLIAM PAUL (MSPT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:PAUL
Last Name:LOOYENGA
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3618 CANYON LAKE DR
Mailing Address - Street 2:STE 111
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-1027
Mailing Address - Country:US
Mailing Address - Phone:605-341-4449
Mailing Address - Fax:605-341-4448
Practice Address - Street 1:3618 CANYON LAKE DR
Practice Address - Street 2:STE 111
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-1027
Practice Address - Country:US
Practice Address - Phone:605-341-4449
Practice Address - Fax:605-341-4448
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1019225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1019OtherLICENSE
SD5832672Medicaid
SDS41146Medicare PIN
SDS41145Medicare PIN