Provider Demographics
NPI:1942316500
Name:KRITZ, LISA HEYING
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:HEYING
Last Name:KRITZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 93
Mailing Address - Street 2:
Mailing Address - City:GUALALA
Mailing Address - State:CA
Mailing Address - Zip Code:95445-0093
Mailing Address - Country:US
Mailing Address - Phone:707-884-4121
Mailing Address - Fax:707-884-4121
Practice Address - Street 1:38550 S HIGHWAY 1
Practice Address - Street 2:SUITE #B
Practice Address - City:GUALALA
Practice Address - State:CA
Practice Address - Zip Code:95445-8592
Practice Address - Country:US
Practice Address - Phone:707-884-4121
Practice Address - Fax:707-884-4121
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT12766225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PT12766Medicare ID - Type Unspecified