Healthcare Provider Details

I. General information

NPI: 1184731861
Provider Name (Legal Business Name): REBECCA ELLEN LOUKO PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 COLLEGE PKWY
COLCHESTER VT
05446-3007
US

IV. Provider business mailing address

6 GOODMAN RD
FAIRFAX VT
05454-5499
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-0142
  • Fax: 802-847-6943
Mailing address:
  • Phone: 802-849-2430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number040-0002987
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: