Provider Demographics
NPI:1033584537
Name:LOTT, IAN GRANT (DPT)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:GRANT
Last Name:LOTT
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4191 N LANDAR DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463-8906
Mailing Address - Country:US
Mailing Address - Phone:561-676-4907
Mailing Address - Fax:
Practice Address - Street 1:16690 SW CHIPOLA RD
Practice Address - Street 2:
Practice Address - City:BLOUNTSTOWN
Practice Address - State:FL
Practice Address - Zip Code:32424-1953
Practice Address - Country:US
Practice Address - Phone:850-674-6405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT309852251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics