Provider Demographics
NPI:1497180830
Name:LOTTES, JOHN RICHARD (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RICHARD
Last Name:LOTTES
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 BROOKVILLE RD
Mailing Address - Street 2:
Mailing Address - City:GLEN HEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11545-3306
Mailing Address - Country:US
Mailing Address - Phone:516-626-6632
Mailing Address - Fax:
Practice Address - Street 1:900 WALT WHITMAN RD
Practice Address - Street 2:SUITE 310
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-2293
Practice Address - Country:US
Practice Address - Phone:631-923-2288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-04
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036718225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist