Provider Demographics
NPI:1013222470
Name:LUNDE, HANNAH KAY (PT)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:KAY
Last Name:LUNDE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:KAY
Other - Last Name:DITTNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2321 STOUT RD
Mailing Address - Street 2:
Mailing Address - City:MENOMONIE
Mailing Address - State:WI
Mailing Address - Zip Code:54751-7003
Mailing Address - Country:US
Mailing Address - Phone:715-235-5531
Mailing Address - Fax:715-233-7645
Practice Address - Street 1:2321 STOUT RD
Practice Address - Street 2:
Practice Address - City:MENOMONIE
Practice Address - State:WI
Practice Address - Zip Code:54751-7003
Practice Address - Country:US
Practice Address - Phone:715-235-5531
Practice Address - Fax:715-233-7645
Is Sole Proprietor?:No
Enumeration Date:2010-08-10
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
WI11601-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist