Healthcare Provider Details

I. General information

NPI: 1780414250
Provider Name (Legal Business Name): JACQUELINE LOUISE LOCSIN DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2024
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 DIVISION AVE STE T
EUGENE OR
97404-2485
US

IV. Provider business mailing address

1580 SAWGRASS CORPORATE PKWY
SUNRISE FL
33323-2869
US

V. Phone/Fax

Practice location:
  • Phone: 541-418-4590
  • Fax:
Mailing address:
  • Phone: 954-739-4247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number308754
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number65480
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12494
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: