Provider Demographics
NPI:1336758267
Name:LOTT, RACHEL TYRONE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:TYRONE
Last Name:LOTT
Suffix:
Gender:F
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 1:3964 GOODMAN RD E STE 105
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38672-8711
Mailing Address - Country:US
Mailing Address - Phone:662-932-4625
Mailing Address - Fax:662-932-4626
Practice Address - Street 1:3964 GOODMAN RD E STE 105
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38672-8711
Practice Address - Country:US
Practice Address - Phone:901-932-4625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-27
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT68782251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty