Provider Demographics
NPI:1841795838
Name:LOFGREN, TARA
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:LOFGREN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8701 HURON ST APT 4-103
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80260-4340
Mailing Address - Country:US
Mailing Address - Phone:303-968-6888
Mailing Address - Fax:
Practice Address - Street 1:8701 HURON ST APT 4-103
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80260-4340
Practice Address - Country:US
Practice Address - Phone:303-968-6888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-29
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT0005915225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COMT0005915OtherCOLORADO DEPARTMENT OF REGULATORY AGENCIES