Provider Demographics
NPI:1255387304
Name:LOTT, JASON A (PT)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:A
Last Name:LOTT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:415 TOWN PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-3487
Mailing Address - Country:US
Mailing Address - Phone:706-868-1707
Mailing Address - Fax:706-868-1351
Practice Address - Street 1:415 TOWN PARK BLVD
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809
Practice Address - Country:US
Practice Address - Phone:706-868-1707
Practice Address - Fax:706-868-1351
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GAPT003706225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAQ61364Medicare UPIN