Individual
LAURA BETH LOOMIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
245 NORTH ST, BRISTOL, VA 24201-3274
(276) 669-4711
(276) 669-0834
Mailing address
2311 KEYES LN, JOHNSON CITY, TN 37601-2011
(423) 914-1095
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2306602165
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2306602165
PTA LICENSE NUMBER
VA
01
—
PTA0000003077
PTA LICENSE NUMBER
TN
Enumeration date
09/16/2006
Last updated
07/08/2007
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