Provider Demographics
NPI:1760778310
Name:WHITMER, LISA (MPT)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:WHITMER
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 1:1730 STONEGATE DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:IL
Mailing Address - Zip Code:60538-3338
Mailing Address - Country:US
Mailing Address - Phone:630-801-1915
Mailing Address - Fax:
Practice Address - Street 1:101 GARDEN ST
Practice Address - Street 2:
Practice Address - City:YORKVILLE
Practice Address - State:IL
Practice Address - Zip Code:60560-9197
Practice Address - Country:US
Practice Address - Phone:630-553-3542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070011950225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist