Healthcare Provider Details

I. General information

NPI: 1326140724
Provider Name (Legal Business Name): WILLIAM HUNT LOFTHOUSE KT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5TH AND ROOSEVELT HINES VA HOSPITAL
HINES IL
60141
US

IV. Provider business mailing address

919 N 9TH ST
DEKALB IL
60115-2507
US

V. Phone/Fax

Practice location:
  • Phone: 708-202-3937
  • Fax:
Mailing address:
  • Phone: 815-756-1958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code226300000X
TaxonomyKinesiotherapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: