Provider Demographics
NPI:1962567271
Name:LOTT, PHILIP BENNETT (LPTA)
Entity type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:BENNETT
Last Name:LOTT
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15110 CARLBERN DR
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-1431
Mailing Address - Country:US
Mailing Address - Phone:703-803-3043
Mailing Address - Fax:
Practice Address - Street 1:19441 GOLF VISTA PLAZA
Practice Address - Street 2:SUITE 230
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176
Practice Address - Country:US
Practice Address - Phone:703-724-7474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306001158225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant