MEDICARE: LISA STUTZMAN PHYSICAL THERAPY PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	02504	IA

General Provider Information

NPI Number	:	1063519692
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LISA STUTZMAN PHYSICAL THERAPY PC

Provider Business Mailing Address
First Line	:	115 N MILL ST
Second Line	:
City	:	LAKE MILLS
State	:	IA
Zip	:	50450-1303
Country	:	US
Telephone Number	:	641-592-3500
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 N MILL ST
Second Line	:
City	:	LAKE MILLS
State	:	IA
Zip	:	50450-1303
Country	:	US
Telephone Number	:	641-592-3500
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LISA K STUTZMAN
Credential	:	MPT
Telephone Number	:	641-592-3500

Provider Enumeration Date	:	09/17/2006
Last Update Date	:	03/29/2012

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