Provider Demographics
NPI:1154038784
Name:LUTZ, KRISTIN (PTA)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:LUTZ
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:MCKINLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:5389 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT AUBURN
Mailing Address - State:IA
Mailing Address - Zip Code:52313-9650
Mailing Address - Country:US
Mailing Address - Phone:319-721-0899
Mailing Address - Fax:
Practice Address - Street 1:502 N 9TH AVE
Practice Address - Street 2:
Practice Address - City:VINTON
Practice Address - State:IA
Practice Address - Zip Code:52349-2254
Practice Address - Country:US
Practice Address - Phone:319-472-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001284225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant