Provider Demographics
NPI:1427572635
Name:LOFTHUS, SARAH ANN (LMP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ANN
Last Name:LOFTHUS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11471 BUSINESS BLVD UNIT 770154
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-0154
Mailing Address - Country:US
Mailing Address - Phone:907-726-3712
Mailing Address - Fax:
Practice Address - Street 1:16611 FARM AVE
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7667
Practice Address - Country:US
Practice Address - Phone:907-726-3712
Practice Address - Fax:907-726-3712
Is Sole Proprietor?:No
Enumeration Date:2017-07-29
Last Update Date:2017-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK122538225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist