Healthcare Provider Details

I. General information

NPI: 1780009324
Provider Name (Legal Business Name): ANGELICA LOUP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2014
Last Update Date: 02/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2850 RUBY VISTA DR
ELKO NV
89801-1615
US

IV. Provider business mailing address

2850 RUBY VISTA DR
ELKO NV
89801-1615
US

V. Phone/Fax

Practice location:
  • Phone: 775-753-5500
  • Fax: 888-543-2289
Mailing address:
  • Phone: 775-753-5500
  • Fax: 888-543-2289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA-0405
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: