Provider Demographics
NPI:1346669538
Name:LOZANO, JONATHAN (DPT)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:
Last Name:LOZANO
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 1:2916 ARCHDALE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-4608
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:870 GOLD HILL RD
Practice Address - Street 2:SUITE 103
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-8985
Practice Address - Country:US
Practice Address - Phone:803-835-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-15
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL29004225100000X
SC8253225100000X
NC16199225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist