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1285128645 NPI number — TREYLAN K LOFTIS MS, ATC, LAT, EP-C

NPI Number: 1285128645
Health Care Provider/Practitioner: TREYLAN K LOFTIS MS, ATC, LAT, EP-C

Information about “1285128645” NPI (TREYLAN K LOFTIS MS, ATC, LAT, EP-C) exists in 1285128645 in HTML format HTML  |  1285128645 in plain Text format TXT  |  1285128645 in PDF (Portable Document Format) PDF  |  1285128645 in an XML format XML  formats.

NPI Number : 1285128645 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1285128645",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "LOFTIS",
    "FirstName": "TREYLAN",
    "MiddleName": "K",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MS, ATC, LAT, EP-C",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "630 SHEPARD LN",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FARMINGTON",
    "MailingAddressStateName": "UT",
    "MailingAddressPostalCode": "84025-3934",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "303-596-8959",
    "MailingAddressFaxNumber": "385-206-8657",
    "FirstLinePracticeLocationAddress": "630 SHEPARD LN",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FARMINGTON",
    "PracticeLocationAddressStateName": "UT",
    "PracticeLocationAddressPostalCode": "84025-3934",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "303-596-8959",
    "PracticeLocationAddressFaxNumber": "385-206-8657",
    "EnumerationDate": "06/19/2018",
    "LastUpdateDate": "07/09/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "2255A2300X",
        "TaxonomyName": "Athletic Trainer",
        "LicenseNumber": "10850158-4810",
        "LicenseNumberStateCode": "UT",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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