Provider Demographics
NPI:1912126855
Name:LOQUIERE, JESSERICA (PT)
Entity type:Individual
Prefix:MRS
First Name:JESSERICA
Middle Name:
Last Name:LOQUIERE
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 1:1230 E WASHINGTON ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-6450
Mailing Address - Country:US
Mailing Address - Phone:909-825-6716
Mailing Address - Fax:909-825-4339
Practice Address - Street 1:411 N CENTRAL AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-2081
Practice Address - Country:US
Practice Address - Phone:818-549-9764
Practice Address - Fax:818-549-9767
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT28533225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist