Healthcare Provider Details

I. General information

NPI: 1861306854
Provider Name (Legal Business Name): THERESE MARIE LOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1671 PENFIELD RD
ROCHESTER NY
14625-2568
US

IV. Provider business mailing address

1671 PENFIELD RD
ROCHESTER NY
14625-2568
US

V. Phone/Fax

Practice location:
  • Phone: 585-203-1948
  • Fax: 585-486-7819
Mailing address:
  • Phone: 585-203-1948
  • Fax: 585-486-7819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number027079
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: