Provider Demographics
NPI:1710970272
Name:TREADWAY-KURTZ, LISA JACQUELINE (ATC)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:JACQUELINE
Last Name:TREADWAY-KURTZ
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 VERNON RD
Mailing Address - Street 2:
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-2812
Mailing Address - Country:US
Mailing Address - Phone:215-576-6933
Mailing Address - Fax:610-526-7425
Practice Address - Street 1:301 VERNON RD
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-2812
Practice Address - Country:US
Practice Address - Phone:215-576-6933
Practice Address - Fax:610-526-7425
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART002514A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer