Healthcare Provider Details

I. General information

NPI: 1902100993
Provider Name (Legal Business Name): PAULA LUTZ MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAULA WATFORD

II. Dates (important events)

Enumeration Date: 01/05/2011
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11055 BROADWAY STE 3
CROWN POINT IN
46307-9177
US

IV. Provider business mailing address

PO BOX 416501
BOSTON MA
02241-6501
US

V. Phone/Fax

Practice location:
  • Phone: 219-342-2869
  • Fax:
Mailing address:
  • Phone: 914-294-4050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05010430A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: