Provider Demographics
NPI:1356524946
Name:LOFGREN, PAMELA K (PT)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:K
Last Name:LOFGREN
Suffix:
Gender:
Credentials:PT
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:K
Other - Last Name:LARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2001 BUTTERFIELD RD STE 1600
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1211
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17500 W BLUEMOUND RD
Practice Address - Street 2:SUITE B
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-2909
Practice Address - Country:US
Practice Address - Phone:262-901-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-06
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6382225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40339400Medicaid
WI100309682Medicaid