Provider Demographics
NPI:1659380053
Name:HULIK, LISA L (DPT)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:L
Last Name:HULIK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:L
Other - Last Name:LATHROP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:801 NW SAINT MARY DR
Mailing Address - Street 2:STE 220
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64014-2524
Mailing Address - Country:US
Mailing Address - Phone:816-220-3900
Mailing Address - Fax:816-220-0877
Practice Address - Street 1:801 NW SAINT MARY DR
Practice Address - Street 2:STE 220
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014-2524
Practice Address - Country:US
Practice Address - Phone:816-220-3900
Practice Address - Fax:816-220-0877
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003029135225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO33561014OtherBCBS KC
266552Medicare ID - Type Unspecified