MEDICARE: CHANDRIKA LOTWALA DPT

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	1275	AZ

General Provider Information

NPI Number	:	1871590174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANDRIKA LOTWALA DPT

Provider Business Mailing Address
First Line	:	10324 N 62ND DR
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85302-1231
Country	:	US
Telephone Number	:	623-979-0066
Fax Number	:	623-979-0052

Provider Business Practice Location Address
First Line	:	2122 E HIGHLAND AVE
Second Line	:	SUITE 200
City	:	PHOENIX
State	:	AZ
Zip	:	85016-4739
Country	:	US
Telephone Number	:	602-778-0900
Fax Number	:	602-778-6606

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

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	01/29/2013

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