Provider Demographics
NPI:1003080300
Name:LUTZ, SUE AILEEN (PT)
Entity Type:Individual
Prefix:MRS
First Name:SUE
Middle Name:AILEEN
Last Name:LUTZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 306
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:IL
Mailing Address - Zip Code:60083-0306
Mailing Address - Country:US
Mailing Address - Phone:262-206-1567
Mailing Address - Fax:262-248-9479
Practice Address - Street 1:36550 HUNT CLUB
Practice Address - Street 2:PFP
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031
Practice Address - Country:US
Practice Address - Phone:262-206-1567
Practice Address - Fax:262-248-9479
Is Sole Proprietor?:No
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist