Provider Demographics
NPI:1225516982
Name:LOTT, MALLORY KATHRYN (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:MALLORY
Middle Name:KATHRYN
Last Name:LOTT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5606 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:HARAHAN
Mailing Address - State:LA
Mailing Address - Zip Code:70123-5111
Mailing Address - Country:US
Mailing Address - Phone:504-733-0254
Mailing Address - Fax:
Practice Address - Street 1:234 LOYOLA AVE STE 302
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-2026
Practice Address - Country:US
Practice Address - Phone:504-407-3440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-03
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA100412251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic