Provider Demographics
NPI:1215229752
Name:LOOMIS, THERESA A (RD)
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:A
Last Name:LOOMIS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 NOTTINGHAM WAY S
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-1715
Mailing Address - Country:US
Mailing Address - Phone:518-429-7506
Mailing Address - Fax:
Practice Address - Street 1:17 NOTTINGHAM WAY S
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-1715
Practice Address - Country:US
Practice Address - Phone:518-429-7506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-03
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered