Provider Demographics
NPI:1104996990
Name:LUND, PAMELA A (LMT)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:A
Last Name:LUND
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21W615 DORCHESTER CT
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-6411
Mailing Address - Country:US
Mailing Address - Phone:630-469-3079
Mailing Address - Fax:
Practice Address - Street 1:21W615 DORCHESTER CT
Practice Address - Street 2:
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-6411
Practice Address - Country:US
Practice Address - Phone:630-469-3079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist