Provider Demographics
NPI:1386147205
Name:HUNTOON, LISA J (PT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:J
Last Name:HUNTOON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 HOLTON WHITEHALL RD
Mailing Address - Street 2:
Mailing Address - City:TWIN LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49457-9445
Mailing Address - Country:US
Mailing Address - Phone:231-730-1644
Mailing Address - Fax:
Practice Address - Street 1:1 STATE RD STE 300
Practice Address - Street 2:
Practice Address - City:NEWAYGO
Practice Address - State:MI
Practice Address - Zip Code:49337-7981
Practice Address - Country:US
Practice Address - Phone:231-355-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-16
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI55010034003225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist