=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659777878
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KERRY LOFFLER RMT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/16/2014
-----------------------------------------------------
Last Update Date | 11/16/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2807 DUNBAR AVE
-----------------------------------------------------
City | FORT COLLINS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80526-2279
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-222-6187
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6671 STOVE PRAIRIE RD
-----------------------------------------------------
City | BELLVUE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80512-6919
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-222-6187
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 10232
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------