Provider Demographics
NPI:1760598098
Name:LOTT, JILL V (P T)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:V
Last Name:LOTT
Suffix:
Gender:F
Credentials:P T
Other - Prefix:
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Mailing Address - Street 1:2200 US HWY 98 SUITE 4
Mailing Address - Street 2:# 320
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526
Mailing Address - Country:US
Mailing Address - Phone:251-990-9082
Mailing Address - Fax:251-990-3707
Practice Address - Street 1:8720 RAND AVE
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-9102
Practice Address - Country:US
Practice Address - Phone:251-990-9082
Practice Address - Fax:251-990-3707
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ALPTH3828225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51503483OtherBLUE CROSS BLUE SHIELD
P40417Medicare UPIN