MEDICARE: LOFTHUS, LLC

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	261QP3300X	Pain Clinic/Center	122538	AK

General Provider Information

NPI Number	:	1750807988
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOFTHUS, LLC

Provider Business Mailing Address
First Line	:	11471 BUSINESS BLVD UNIT 770154
Second Line	:
City	:	EAGLE RIVER
State	:	AK
Zip	:	99577-0040
Country	:	US
Telephone Number	:	19077263712
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	:

Authorized Official
Title or Position	:	THERAPIST
Name	:	SARAH A LOFTHUS
Credential	:	LMT
Telephone Number	:	907-726-3712

Provider Enumeration Date	:	08/18/2017
Last Update Date	:	08/18/2017

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