Provider Demographics
NPI:1265576920
Name:KRANTZ, LISA K (PT, ATC)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:K
Last Name:KRANTZ
Suffix:
Gender:F
Credentials:PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 CHESTNUT AVE
Mailing Address - Street 2:STE A: NORTHSHORE UNIVERSITY HEALTH SYSTEM: PARK CENTER
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-8321
Mailing Address - Country:US
Mailing Address - Phone:847-657-3520
Mailing Address - Fax:847-657-3521
Practice Address - Street 1:2400 CHESTNUT AVE
Practice Address - Street 2:STE A :NORTHSHORE UNIVERSITY HEALTH SYSTEM
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-8321
Practice Address - Country:US
Practice Address - Phone:847-657-3520
Practice Address - Fax:847-657-3521
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10742024225100000X
IL096.0029942255A2300X
IL070018147225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI36128300Medicaid
WI36128300Medicaid
WI001786443Medicare PIN