Provider Demographics
NPI:1144310699
Name:LOTZE, NICHOLAS SCOTT (RPT)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:SCOTT
Last Name:LOTZE
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 MARGARET LN
Mailing Address - Street 2:SUITE B
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5212
Mailing Address - Country:US
Mailing Address - Phone:530-273-7500
Mailing Address - Fax:530-273-7551
Practice Address - Street 1:104 MARGARET LN
Practice Address - Street 2:SUITE B
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5212
Practice Address - Country:US
Practice Address - Phone:530-273-7500
Practice Address - Fax:530-273-7551
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT13012225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT13012OtherRPT
CA0PT130120Medicare PIN