Provider Demographics
NPI:1225112683
Name:LOFTON, AMY NICHOLE (PT)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:NICHOLE
Last Name:LOFTON
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 1:1985 SANFORD RD
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:TN
Mailing Address - Zip Code:38340-1241
Mailing Address - Country:US
Mailing Address - Phone:731-989-3365
Mailing Address - Fax:
Practice Address - Street 1:412 JUANITA DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:TN
Practice Address - Zip Code:38340-1949
Practice Address - Country:US
Practice Address - Phone:731-989-7598
Practice Address - Fax:731-989-7994
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5519225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist