Provider Demographics
NPI:1578702783
Name:LOFTUS, SUSAN K (LMP MSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:K
Last Name:LOFTUS
Suffix:
Gender:F
Credentials:LMP MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9046 NORTHTOWN DR
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-3521
Mailing Address - Country:US
Mailing Address - Phone:206-842-2014
Mailing Address - Fax:
Practice Address - Street 1:262 WINSLOW WAY E
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-2430
Practice Address - Country:US
Practice Address - Phone:206-484-3863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00025353225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist