Provider Demographics
NPI:1346643541
Name:LOTHIAN, DYLAN (ATC)
Entity Type:Individual
Prefix:
First Name:DYLAN
Middle Name:
Last Name:LOTHIAN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 CROYDEN AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-3320
Mailing Address - Country:US
Mailing Address - Phone:802-370-2251
Mailing Address - Fax:
Practice Address - Street 1:333 S CLARK ST
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MI
Practice Address - Zip Code:49328-9501
Practice Address - Country:US
Practice Address - Phone:802-370-2251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-01
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer