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General NPI Number Information
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NPI Number | 1427287952
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Entity Type | Individual
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Provider Name | LISA ANNE LUTTRULL DPT
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Gender | Female
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Dates
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Enumeration Date | 07/06/2009
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Last Update Date | 07/03/2010
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Provider Practice Location Address
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Address Line | 2130 W US HIGHWAY 10
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City | LUDINGTON
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State | MI
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Zip | 49431-8319
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Country | US
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Telephone | 231-757-3716
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Fax |
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Provider Business Mailing Address
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Address Line | 2130 W US HIGHWAY 10
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City | LUDINGTON
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State | MI
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Zip | 49431-8319
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Country | US
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Telephone | 231-757-3716
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501012450
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License Number State | MI
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