Provider Demographics
NPI:1952413270
Name:LOTIVIO, BENJAMIN BAHIA JR (PT)
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:BAHIA
Last Name:LOTIVIO
Suffix:JR
Gender:
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3614 W ANDREW JOHNSON HWY
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-3602
Mailing Address - Country:US
Mailing Address - Phone:423-586-9495
Mailing Address - Fax:423-586-9495
Practice Address - Street 1:3614 W ANDREW JOHNSON HWY
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-3602
Practice Address - Country:US
Practice Address - Phone:423-586-9495
Practice Address - Fax:423-586-9549
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3294225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ017195Medicaid
TN446679Medicare ID - Type UnspecifiedOPT