Provider Demographics
NPI:1235368432
Name:LOTT, DONOVAN JONES (PT, PHD, CSCS)
Entity Type:Individual
Prefix:
First Name:DONOVAN
Middle Name:JONES
Last Name:LOTT
Suffix:
Gender:M
Credentials:PT, PHD, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 SW 258TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32669-4133
Mailing Address - Country:US
Mailing Address - Phone:352-474-6111
Mailing Address - Fax:
Practice Address - Street 1:22 SW 258TH ST
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:FL
Practice Address - Zip Code:32669-4133
Practice Address - Country:US
Practice Address - Phone:352-474-6111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-09
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23428225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist