Provider Demographics
NPI:1912563487
Name:JUNDI, LISA MARIE (PT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:JUNDI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3012 GRAHAM RD
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-3622
Mailing Address - Country:US
Mailing Address - Phone:330-805-4786
Mailing Address - Fax:866-954-0507
Practice Address - Street 1:3012 GRAHAM RD
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-3622
Practice Address - Country:US
Practice Address - Phone:216-469-5752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-10
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH9925225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist