Basic Information
| Provider Information | |||||||||
| NPI: | 1750401105 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LOFTIS | ||||||||
| FirstName: | TIFFANY | ||||||||
| MiddleName: | K. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | P.T. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ARBUCKLE | ||||||||
| OtherFirstName: | TIFFANY | ||||||||
| OtherMiddleName: | K. | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 10304 ELK CANYON RD | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731626615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056204410 | ||||||||
| FaxNumber: | 4054703345 | ||||||||
| Practice Location | |||||||||
| Address1: | 7100 SOUTH I-35 SERVICE RD | ||||||||
| Address2: | SUITE 7 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 73149 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056321002 | ||||||||
| FaxNumber: | 4056323131 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2007 | ||||||||
| LastUpdateDate: | 08/03/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2668 | OK | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.