1447233770 NPI number — MRS. LORAINE LOVEJOY-EVANS MPT, DPT

Table of content: MRS. LORAINE LOVEJOY-EVANS MPT, DPT (NPI 1447233770)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447233770 NPI number — MRS. LORAINE LOVEJOY-EVANS MPT, DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOVEJOY-EVANS
Provider First Name:
LORAINE
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MPT, DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PHYSICAL THERAPY
Provider Other First Name:
INDEPENDENCE
Provider Other Middle Name:
THROUGH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1447233770
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 572
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARLSBORG
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98324-0572
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-683-6101
Provider Business Mailing Address Fax Number:
360-683-6102

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
865 CARLSBORG RD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
SEQUIM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98382-8390
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-683-6101
Provider Business Practice Location Address Fax Number:
360-683-6102
Provider Enumeration Date:
11/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT00005999 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0160256 . This is a "LABOR & INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 9259LO . This is a "REGENCE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8324568 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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