Provider Demographics
NPI:1942321344
Name:CHURCHILL, LOLITA MARIE (MPT)
Entity type:Individual
Prefix:MS
First Name:LOLITA
Middle Name:MARIE
Last Name:CHURCHILL
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 ATHENS ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112-2101
Mailing Address - Country:US
Mailing Address - Phone:415-279-8959
Mailing Address - Fax:
Practice Address - Street 1:101 ATHENS ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94112-2101
Practice Address - Country:US
Practice Address - Phone:415-279-8959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 29752225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist