Provider Demographics
NPI:1558861310
Name:LOFT, MICHELE ANN (LMT, LAC)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:ANN
Last Name:LOFT
Suffix:
Gender:F
Credentials:LMT, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 NICHOLS RD
Mailing Address - Street 2:
Mailing Address - City:NESCONSET
Mailing Address - State:NY
Mailing Address - Zip Code:11767-2115
Mailing Address - Country:US
Mailing Address - Phone:631-365-0154
Mailing Address - Fax:
Practice Address - Street 1:148 NICHOLS RD
Practice Address - Street 2:
Practice Address - City:NESCONSET
Practice Address - State:NY
Practice Address - Zip Code:11767-2115
Practice Address - Country:US
Practice Address - Phone:631-365-0154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-19
Last Update Date:2023-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030326-1225700000X
NY007348171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist