Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | IL |
NPI | 1003080300 |
---|---|
Provider Name | Mrs. Sue Aileen Lutz |
First Address | Wadsworth, IL 60083-0306 |
Second Address | Gurnee, IL 60031 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2008 |
Last Update Date | 17/04/2008 |