MEDICARE: TREVOR LOTZ

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	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1881142347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TREVOR LOTZ

Provider Business Mailing Address
First Line	:	206 DANA ST
Second Line	:
City	:	POTTSVILLE
State	:	PA
Zip	:	17901-4005
Country	:	US
Telephone Number	:	570-449-4448
Fax Number	:

Provider Business Practice Location Address
First Line	:	206 DANA ST
Second Line	:
City	:	POTTSVILLE
State	:	PA
Zip	:	17901-4005
Country	:	US
Telephone Number	:	570-449-4448
Fax Number	:

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

Provider Enumeration Date	:	09/13/2016
Last Update Date	:	07/08/2017

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Directions to “ TREVOR LOTZ ” Practice Location

Language	Start Address	Practice Location

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