Provider Demographics
NPI:1457492472
Name:LOTT, KENNETH LESTER (PT)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:LESTER
Last Name:LOTT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4496 TRAVIS DR
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30566-2115
Mailing Address - Country:US
Mailing Address - Phone:770-532-7441
Mailing Address - Fax:770-532-7441
Practice Address - Street 1:4496 TRAVIS DR
Practice Address - Street 2:
Practice Address - City:OAKWOOD
Practice Address - State:GA
Practice Address - Zip Code:30566-2115
Practice Address - Country:US
Practice Address - Phone:770-532-7441
Practice Address - Fax:770-532-7441
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT001056225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist