Provider Demographics
NPI:1164699062
Name:LOFTHUS, JOAN E (PTA)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:E
Last Name:LOFTHUS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 WATER ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04937-1535
Mailing Address - Country:US
Mailing Address - Phone:207-453-9458
Mailing Address - Fax:
Practice Address - Street 1:40 WATER ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:ME
Practice Address - Zip Code:04937-1535
Practice Address - Country:US
Practice Address - Phone:207-453-9458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-11
Last Update Date:2008-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA1574314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEPA1574OtherPTA LICENSE