Provider Demographics
NPI:1366653446
Name:LUTZ, SUSAN NARA (PT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:NARA
Last Name:LUTZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:NARA
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:308 E BARAGA AVE
Mailing Address - Street 2:
Mailing Address - City:HOUGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:49931-2000
Mailing Address - Country:US
Mailing Address - Phone:906-483-0235
Mailing Address - Fax:
Practice Address - Street 1:540 DEPOT ST
Practice Address - Street 2:
Practice Address - City:HANCOCK
Practice Address - State:MI
Practice Address - Zip Code:49930-2031
Practice Address - Country:US
Practice Address - Phone:906-482-7382
Practice Address - Fax:906-482-9410
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501002832225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist