Provider Demographics
NPI:1285096578
Name:LOEHR, SEAN (MT)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:LOEHR
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11510 NE 112TH DR
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-3264
Mailing Address - Country:US
Mailing Address - Phone:360-798-7642
Mailing Address - Fax:
Practice Address - Street 1:1436 NW BENTON ST
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-1542
Practice Address - Country:US
Practice Address - Phone:360-904-5145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60501792225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist