Provider Demographics
NPI:1558318592
Name:STUTZMAN, LISA KAY (MPT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:KAY
Last Name:STUTZMAN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 WHISPER LN
Mailing Address - Street 2:
Mailing Address - City:RANCHESTER
Mailing Address - State:WY
Mailing Address - Zip Code:82839-8530
Mailing Address - Country:US
Mailing Address - Phone:307-655-6991
Mailing Address - Fax:
Practice Address - Street 1:512 MAIN ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:WY
Practice Address - Zip Code:82836-5056
Practice Address - Country:US
Practice Address - Phone:307-655-2509
Practice Address - Fax:307-655-2275
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPT-0964174400000X, 225100000X, 225100000X
IA02504225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI18602Medicare ID - Type Unspecified
IAI22052Medicare PIN