Provider Demographics
NPI:1821189929
Name:LOESCH, PHILLIP ALBERT (ATC, CSCS)
Entity type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:ALBERT
Last Name:LOESCH
Suffix:
Gender:M
Credentials:ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:3209 N STATE RD
Mailing Address - Street 2:
Mailing Address - City:HARBOR SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49740-9756
Mailing Address - Country:US
Mailing Address - Phone:231-242-1151
Mailing Address - Fax:
Practice Address - Street 1:4048 CEDAR BLUFF DR
Practice Address - Street 2:SUITE 2
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-8895
Practice Address - Country:US
Practice Address - Phone:231-347-9300
Practice Address - Fax:231-347-1613
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer