Provider Demographics
NPI:1174717771
Name:LOFTON, THOMAS ALLEN (PTA)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:ALLEN
Last Name:LOFTON
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36291 W PINE GROVE CT
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-3461
Mailing Address - Country:US
Mailing Address - Phone:225-287-8195
Mailing Address - Fax:225-677-8665
Practice Address - Street 1:36291 W PINE GROVE CT
Practice Address - Street 2:
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-3461
Practice Address - Country:US
Practice Address - Phone:225-287-8195
Practice Address - Fax:225-677-8665
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAA5168174400000X
MSPTA4191174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist