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General NPI Number Information
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NPI Number | 1649702705
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Entity Type | Individual
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Provider Name | JAIME LOUDENSLAGER
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Gender | Female
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Dates
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Enumeration Date | 03/29/2017
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Last Update Date | 03/29/2017
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Provider Practice Location Address
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Address Line | 4625 S GARRISON CHAPEL RD
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City | BLOOMINGTON
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State | IN
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Zip | 47403-9763
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Country | US
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Telephone | 812-340-6214
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Fax |
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Provider Business Mailing Address
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Address Line | 4625 S GARRISON CHAPEL RD
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City | BLOOMINGTON
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State | IN
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Zip | 47403-9763
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 06003396A
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License Number State | IN
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