Healthcare Provider Details

I. General information

NPI: 1962369645
Provider Name (Legal Business Name): THOMAS LOFTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 S LONGMORE STE 2
MESA AZ
85202-9607
US

IV. Provider business mailing address

1303 S LONGMORE STE 2
MESA AZ
85202-9607
US

V. Phone/Fax

Practice location:
  • Phone: 480-712-5181
  • Fax:
Mailing address:
  • Phone: 480-712-5181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-467327
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: