Provider Demographics
NPI:1386978948
Name:LOFORTI, MICHAEL J (MPT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:LOFORTI
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4040 ORCHARD ST W
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FIRCREST
Mailing Address - State:WA
Mailing Address - Zip Code:98466-6606
Mailing Address - Country:US
Mailing Address - Phone:253-564-1560
Mailing Address - Fax:253-564-4449
Practice Address - Street 1:9505 S STEELE ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98444-1858
Practice Address - Country:US
Practice Address - Phone:253-770-1807
Practice Address - Fax:253-770-1985
Is Sole Proprietor?:No
Enumeration Date:2009-09-29
Last Update Date:2021-04-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAPT60113876225100000X, 2251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8886105Medicare PIN
WAG8886104Medicare PIN