Provider Demographics
NPI:1376617951
Name:LOTT, KRISTINA (PT)
Entity Type:Individual
Prefix:MS
First Name:KRISTINA
Middle Name:
Last Name:LOTT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4440 N 36TH ST
Mailing Address - Street 2:240
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-3588
Mailing Address - Country:US
Mailing Address - Phone:602-956-4040
Mailing Address - Fax:602-956-4011
Practice Address - Street 1:4440 N 36TH ST
Practice Address - Street 2:240
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-3588
Practice Address - Country:US
Practice Address - Phone:602-956-4040
Practice Address - Fax:602-956-4011
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6024225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ120355OtherMEDICARE PROVIDER TRANSACTION ACCESS NUMBER (PTAN)
AZ852675OtherAHCCCS ID#
AZAZ0294160OtherBCBS OF AZ PROVIDER ID#
AZAZ0294160OtherBCBS OF AZ PROVIDER ID#
AZ852675OtherAHCCCS ID#
AZZ63123Medicare PIN