Provider Demographics
NPI:1235286071
Name:LOTT, DIANE PHILLIPS (PT)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:PHILLIPS
Last Name:LOTT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:MARY
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:12779 MISTY CREEK LN
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-1728
Mailing Address - Country:US
Mailing Address - Phone:703-715-3431
Mailing Address - Fax:
Practice Address - Street 1:2 PIDGEON HILL DR
Practice Address - Street 2:SUITE 280
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165-6145
Practice Address - Country:US
Practice Address - Phone:703-404-1807
Practice Address - Fax:703-404-1827
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305003352225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist