Provider Demographics
NPI:1285680041
Name:LOFGREN, MARIA E (PT)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:E
Last Name:LOFGREN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:E
Other - Last Name:LOFGREN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:4235 POLO PONY RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83001-8974
Mailing Address - Country:US
Mailing Address - Phone:307-734-9129
Mailing Address - Fax:307-734-1427
Practice Address - Street 1:120 W PEARL AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001-8657
Practice Address - Country:US
Practice Address - Phone:307-734-9129
Practice Address - Fax:307-734-1427
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPT971225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist