Provider Demographics
NPI:1477108942
Name:KUTZ, LISSA (DPT)
Entity Type:Individual
Prefix:
First Name:LISSA
Middle Name:
Last Name:KUTZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 LEXINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19543-8853
Mailing Address - Country:US
Mailing Address - Phone:610-207-2818
Mailing Address - Fax:
Practice Address - Street 1:2758 CENTURY BLVD STE 3
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-3358
Practice Address - Country:US
Practice Address - Phone:610-376-5467
Practice Address - Fax:610-376-5454
Is Sole Proprietor?:No
Enumeration Date:2019-08-01
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT020895225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist