Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 4677 | OK |
N | 2251S0007X | Physical Therapist - Sports | ||
N | 2251X0800X | Physical Therapist - Orthopedic |
NPI | 1548621691 |
---|---|
Provider Name | Charles Loftis |
First Address | Oklahoma City, OK 73135-3175 |
Second Address | Edmond, OK 73003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2016 |
Last Update Date | 17/03/2016 |