Provider Demographics
NPI:1386762649
Name:LOECKE, JODI L (PT)
Entity type:Individual
Prefix:MS
First Name:JODI
Middle Name:L
Last Name:LOECKE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5881 W 16TH ST
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-2910
Mailing Address - Country:US
Mailing Address - Phone:970-313-2775
Mailing Address - Fax:970-313-2777
Practice Address - Street 1:5881 W 16TH ST
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-2910
Practice Address - Country:US
Practice Address - Phone:970-313-2775
Practice Address - Fax:970-313-2777
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8459225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP00944886OtherMEDICARE RAILROAD CARRIER PTAN
CO21172293Medicaid
COC809686Medicare PIN
COCOA104339Medicare PIN
COCO305621Medicare PIN