Healthcare Provider Details

I. General information

NPI: 1891920468
Provider Name (Legal Business Name): LISA MARIE SOTTUNG PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2009
Last Update Date: 06/28/2023
Certification Date: 06/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1319 MILITARY CUTOFF RD STE LL
WILMINGTON NC
28405-3640
US

IV. Provider business mailing address

1845 S MOORINGS DR
WILMINGTON NC
28405-5336
US

V. Phone/Fax

Practice location:
  • Phone: 908-868-9534
  • Fax:
Mailing address:
  • Phone: 908-868-9534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberP21632
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberQA03601
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: