MEDICARE: MRS. HELGA LOTT PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	42	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NV7604	OTHER		BC BS FEP

General Provider Information

NPI Number	:	1407833114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HELGA LOTT PT

Provider Business Mailing Address
First Line	:	1700 E DESERT INN RD
Second Line	:	STE 114
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-3206
Country	:	US
Telephone Number	:	702-734-8642
Fax Number	:	702-734-8912

Provider Business Practice Location Address
First Line	:	1700 E DESERT INN RD
Second Line	:	STE 114
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-3206
Country	:	US
Telephone Number	:	702-734-8642
Fax Number	:	702-734-8912

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/23/2005
Last Update Date	:	10/19/2007

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