Healthcare Provider Details

I. General information

NPI: 1427102912
Provider Name (Legal Business Name): GREGORY AARON LOOMIS PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 02/23/2024
Certification Date: 02/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 COCHRANE CIR # B7500
FT CARSON CO
80913-4613
US

IV. Provider business mailing address

3600 RAFTERSRIDGE DR
MIDLOTHIAN VA
23113-3747
US

V. Phone/Fax

Practice location:
  • Phone: 719-526-7000
  • Fax:
Mailing address:
  • Phone: 703-405-5138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305205217
License Number StateVA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: