Provider Demographics
NPI:1508280736
Name:AKYURT, MA LOURDES MAURICIO (PT)
Entity Type:Individual
Prefix:
First Name:MA LOURDES
Middle Name:MAURICIO
Last Name:AKYURT
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 1:130 STRAWBERRY LN
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN RAPIDS
Mailing Address - State:WI
Mailing Address - Zip Code:54494-2156
Mailing Address - Country:US
Mailing Address - Phone:715-424-1600
Mailing Address - Fax:
Practice Address - Street 1:130 STRAWBERRY LN
Practice Address - Street 2:
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54494-2156
Practice Address - Country:US
Practice Address - Phone:715-424-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-07
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12598-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist