Provider Demographics
NPI:1285128645
Name:LOFTIS, TREYLAN K (MS, ATC, LAT, EP-C)
Entity type:Individual
Prefix:
First Name:TREYLAN
Middle Name:K
Last Name:LOFTIS
Suffix:
Gender:M
Credentials:MS, ATC, LAT, EP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 SHEPARD LN
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025-3934
Mailing Address - Country:US
Mailing Address - Phone:303-596-8959
Mailing Address - Fax:385-206-8657
Practice Address - Street 1:630 SHEPARD LN
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025-3934
Practice Address - Country:US
Practice Address - Phone:303-596-8959
Practice Address - Fax:385-206-8657
Is Sole Proprietor?:No
Enumeration Date:2018-06-19
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10850158-48102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer