Provider Demographics
NPI:1427033414
Name:FURTO, LISA L (PT)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:L
Last Name:FURTO
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 5670
Mailing Address - Street 2:5019 ACE LN, SUITE 103
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60567-5670
Mailing Address - Country:US
Mailing Address - Phone:630-904-5530
Mailing Address - Fax:630-904-5580
Practice Address - Street 1:5019 ACE LN STE 103
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-8177
Practice Address - Country:US
Practice Address - Phone:630-904-5530
Practice Address - Fax:630-904-5580
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
363039692001OtherTRICARE
K18560Medicare ID - Type Unspecified