Provider Demographics
NPI:1780869008
Name:LOTT, RICHARD VAN (PT)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:VAN
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 1:4241 WOODCOCK DR STE A100
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228-1337
Mailing Address - Country:US
Mailing Address - Phone:210-785-5200
Mailing Address - Fax:210-785-5383
Practice Address - Street 1:4241 WOODCOCK DR STE A100
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-1337
Practice Address - Country:US
Practice Address - Phone:210-785-5200
Practice Address - Fax:210-785-5383
Is Sole Proprietor?:No
Enumeration Date:2008-01-05
Last Update Date:2008-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1039055225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist