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General NPI Number Information
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NPI Number | 1750807988
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Entity Type | Organization
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Legal Business Name | LOFTHUS, LLC
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Dates
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Enumeration Date | 08/18/2017
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Last Update Date | 08/18/2017
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Provider Practice Location Address
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Address Line | 16611 FARM AVE
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City | EAGLE RIVER
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State | AK
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Zip | 99577-7667
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Country | US
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Telephone | 907-726-3712
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Fax |
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Provider Business Mailing Address
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Address Line | 11471 BUSINESS BLVD UNIT 770154
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City | EAGLE RIVER
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State | AK
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Zip | 99577-0040
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Country | US
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Telephone | 19077263712
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | SARAH A LOFTHUS
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Credential | LMT
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Telephone | 907-726-3712
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number | 122538
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License Number State | AK
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