Provider Demographics
NPI:1487698536
Name:LOFTIN, VIRGINIA S (PT,OCS)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:S
Last Name:LOFTIN
Suffix:
Gender:F
Credentials:PT,OCS
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:S
Other - Last Name:LOFTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT,OCS
Mailing Address - Street 1:8660 FERN AVE STE 160
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5694
Mailing Address - Country:US
Mailing Address - Phone:318-631-9999
Mailing Address - Fax:318-631-9528
Practice Address - Street 1:8660 FERN AVE STE 160
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5694
Practice Address - Country:US
Practice Address - Phone:318-631-7999
Practice Address - Fax:318-631-9528
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA00162R225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4B528C749Medicare PIN