MEDICARE: SARAH ANN LOFTHUS LMP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	122538	AK

General Provider Information

NPI Number	:	1427572635
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH ANN LOFTHUS LMP

Provider Business Mailing Address
First Line	:	11471 BUSINESS BLVD UNIT 770154
Second Line	:
City	:	EAGLE RIVER
State	:	AK
Zip	:	99577-0154
Country	:	US
Telephone Number	:	907-726-3712
Fax Number	:

Provider Business Practice Location Address
First Line	:	16611 FARM AVE
Second Line	:
City	:	EAGLE RIVER
State	:	AK
Zip	:	99577-7667
Country	:	US
Telephone Number	:	907-726-3712
Fax Number	:	907-726-3712

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2017
Last Update Date	:	07/29/2017

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