Healthcare Provider Details

I. General information

NPI: 1841120227
Provider Name (Legal Business Name): CAITLYN LOOS LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10930 SW 190TH AVE
DUNNELLON FL
34432-4569
US

IV. Provider business mailing address

10930 SW 190TH AVE
DUNNELLON FL
34432-4569
US

V. Phone/Fax

Practice location:
  • Phone: 352-464-3668
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA108760
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: