Healthcare Provider Details

I. General information

NPI: 1548621691
Provider Name (Legal Business Name): CHARLES LOFTIS PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2016
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5105 SE 45TH TER
OKLAHOMA CITY OK
73135-3175
US

IV. Provider business mailing address

5105 SE 45TH TER
OKLAHOMA CITY OK
73135-3175
US

V. Phone/Fax

Practice location:
  • Phone: 405-408-3204
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4677
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: