Healthcare Provider Details

I. General information

NPI: 1285666438
Provider Name (Legal Business Name): CARLOS L. LOERA JR. PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 NW 4TH ST APT B
REDMOND OR
97756-1328
US

IV. Provider business mailing address

8293 VIREO CT
REDMOND OR
97756-9661
US

V. Phone/Fax

Practice location:
  • Phone: 541-504-2350
  • Fax: 541-504-2354
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberPT00002041
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number64227
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: