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General NPI Number Information
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NPI Number | 1740748391
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Entity Type | Individual
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Provider Name | EVAN WALTER LOTZ DPT
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Gender | Male
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Dates
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Enumeration Date | 03/02/2019
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Last Update Date | 02/13/2025
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Provider Practice Location Address
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Address Line | 18757 BURBANK BLVD STE 118
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City | TARZANA
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State | CA
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Zip | 91356-6345
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Country | US
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Telephone | 818-812-5300
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Fax |
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Provider Business Mailing Address
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Address Line | 908 W WILLIAM ST
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City | CHAMPAIGN
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State | IL
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Zip | 61821-4511
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Country | US
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Telephone | 217-722-1223
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 295990
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License Number State | CA
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