Provider Demographics
NPI:1326447608
Name:LISA KRITZ PHYSICAL THERAPY INC.
Entity Type:Organization
Organization Name:LISA KRITZ PHYSICAL THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:KRITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-884-4121
Mailing Address - Street 1:PO BOX 93
Mailing Address - Street 2:
Mailing Address - City:GUALALA
Mailing Address - State:CA
Mailing Address - Zip Code:95445-0093
Mailing Address - Country:US
Mailing Address - Phone:707-884-4121
Mailing Address - Fax:707-884-4121
Practice Address - Street 1:38550 S HIGHWAY 1 # B
Practice Address - Street 2:
Practice Address - City:GUALALA
Practice Address - State:CA
Practice Address - Zip Code:95445-8592
Practice Address - Country:US
Practice Address - Phone:707-884-4121
Practice Address - Fax:707-884-4121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-22
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT12766225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty