MEDICARE: WILLIAM PAUL LOOYENGA MSPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1019	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1019	OTHER	SD	LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457412975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM PAUL LOOYENGA MSPT

Provider Business Mailing Address
First Line	:	3618 CANYON LAKE DR
Second Line	:	STE 111
City	:	RAPID CITY
State	:	SD
Zip	:	57702-1027
Country	:	US
Telephone Number	:	605-341-4449
Fax Number	:	605-341-4448

Provider Business Practice Location Address
First Line	:	3618 CANYON LAKE DR
Second Line	:	STE 111
City	:	RAPID CITY
State	:	SD
Zip	:	57702-1027
Country	:	US
Telephone Number	:	605-341-4449
Fax Number	:	605-341-4448

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	10/17/2007

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