Provider Demographics
NPI:1467889618
Name:STANUCH, LISA M (PT, DPT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:STANUCH
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:SCHRAMM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT,DPT
Mailing Address - Street 1:2122 YORK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1925
Mailing Address - Country:US
Mailing Address - Phone:630-575-1980
Mailing Address - Fax:
Practice Address - Street 1:1655 NATIONS DR
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-9178
Practice Address - Country:US
Practice Address - Phone:847-782-9860
Practice Address - Fax:847-782-9866
Is Sole Proprietor?:No
Enumeration Date:2013-10-02
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20427225100000X
IL070019928225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist