Provider Demographics
NPI:1083358493
Name:LOFTIN, KARMA RENA (PT)
Entity Type:Individual
Prefix:
First Name:KARMA
Middle Name:RENA
Last Name:LOFTIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2767 E FM 1188
Mailing Address - Street 2:
Mailing Address - City:BLUFF DALE
Mailing Address - State:TX
Mailing Address - Zip Code:76433-2519
Mailing Address - Country:US
Mailing Address - Phone:601-955-7892
Mailing Address - Fax:
Practice Address - Street 1:300 KICKAPOO CT
Practice Address - Street 2:
Practice Address - City:LIPAN
Practice Address - State:TX
Practice Address - Zip Code:76462-3803
Practice Address - Country:US
Practice Address - Phone:601-955-7892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-21
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1194429225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1194429OtherINSURANCE