MEDICARE: MRS. ELIZABETH M LUNDIN PT, DPT

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	1218856	TX
2	225100000X	Physical Therapist	P15516	NC
3	225100000X	Physical Therapist	7725	SC

General Provider Information

NPI Number	:	1811240153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELIZABETH M LUNDIN PT, DPT

Provider Business Mailing Address
First Line	:	12215 ROYAL TERN DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28278-6963
Country	:	US
Telephone Number	:	828-279-3956
Fax Number	:

Provider Business Practice Location Address
First Line	:	4543 CHARLOTTE HWY STE 11
Second Line	:
City	:	LAKE WYLIE
State	:	SC
Zip	:	29710-7057
Country	:	US
Telephone Number	:	803-831-1454
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2012
Last Update Date	:	12/05/2017

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