Provider Demographics
NPI:1730668369
Name:LOFTIS, KORY
Entity Type:Individual
Prefix:
First Name:KORY
Middle Name:
Last Name:LOFTIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:847 S DOGWOOD ST
Mailing Address - Street 2:
Mailing Address - City:SILOAM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72761-3915
Mailing Address - Country:US
Mailing Address - Phone:479-524-3191
Mailing Address - Fax:
Practice Address - Street 1:847 S DOGWOOD ST
Practice Address - Street 2:
Practice Address - City:SILOAM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72761-3915
Practice Address - Country:US
Practice Address - Phone:479-524-3191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist