=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053918896
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MORGAN AILEEN LOTT PT, DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/05/2020
-----------------------------------------------------
Last Update Date | 06/19/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 920 CEDAR LAKE RD
-----------------------------------------------------
City | BILOXI
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39532-2124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 228-641-2880
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5532 JOHN F KENNEDY BLVD
-----------------------------------------------------
City | NORTH LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72116-6708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-588-3211
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT0001
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------