MEDICARE: DR. PETER V LOUBERT PT, PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	5501001821	MI

General Provider Information

NPI Number	:	1679533319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER V LOUBERT PT, PHD

Provider Business Mailing Address
First Line	:	1305 TOMAH DR
Second Line	:
City	:	MT PLEASANT
State	:	MI
Zip	:	48858-4144
Country	:	US
Telephone Number	:	989-773-1926
Fax Number	:	866-849-6408

Provider Business Practice Location Address
First Line	:	HEALTH PROFESSIONS BUILDING
Second Line	:	CENTRAL MICHIGAN UNIVERSITY
City	:	MT PLEASANT
State	:	MI
Zip	:	48859-0001
Country	:	US
Telephone Number	:	989-774-2396
Fax Number	:	989-774-2433

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2006
Last Update Date	:	07/08/2007

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