Provider Demographics
NPI:1548468986
Name:LOOS, JENNIFER H (DPT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:H
Last Name:LOOS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:HOEDTKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:29 BUTLER DR
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-3510
Mailing Address - Country:US
Mailing Address - Phone:203-815-8324
Mailing Address - Fax:
Practice Address - Street 1:82-86 WOLCOTT HILL RD
Practice Address - Street 2:SUITE 102
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-1252
Practice Address - Country:US
Practice Address - Phone:860-436-3151
Practice Address - Fax:860-436-3277
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2021-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008123225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist