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General NPI Number Information
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NPI Number | 1033584537
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Entity Type | Individual
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Provider Name | IAN GRANT LOTT DPT
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Gender | Male
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Dates
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Enumeration Date | 12/09/2015
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Last Update Date | 12/09/2015
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Provider Practice Location Address
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Address Line | 16690 SW CHIPOLA RD
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City | BLOUNTSTOWN
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State | FL
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Zip | 32424-1953
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Country | US
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Telephone | 850-674-6405
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Fax |
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Provider Business Mailing Address
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Address Line | 4191 N LANDAR DR
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City | LAKE WORTH
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State | FL
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Zip | 33463-8906
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Country | US
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Telephone | 561-676-4907
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251G0304X
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Taxonomy Name | Geriatric Physical Therapist
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License Number | PT30985
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License Number State | FL
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