Healthcare Provider Details

I. General information

NPI: 1083358493
Provider Name (Legal Business Name): KARMA RENA LOFTIN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2022
Last Update Date: 10/04/2022
Certification Date: 10/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 KICKAPOO CT
LIPAN TX
76462-3803
US

IV. Provider business mailing address

2767 E FM 1188
BLUFF DALE TX
76433-2519
US

V. Phone/Fax

Practice location:
  • Phone: 601-955-7892
  • Fax:
Mailing address:
  • Phone: 601-955-7892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1194429
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: