Provider Demographics
NPI:1386297240
Name:DUNN, LISA MARIE (CPTA)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:DUNN
Suffix:
Gender:F
Credentials:CPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 MEADOWLAKE CIR
Mailing Address - Street 2:
Mailing Address - City:VALLEY CENTER
Mailing Address - State:KS
Mailing Address - Zip Code:67147-8413
Mailing Address - Country:US
Mailing Address - Phone:316-755-1130
Mailing Address - Fax:
Practice Address - Street 1:1030 MEADOWLAKE CIR
Practice Address - Street 2:
Practice Address - City:VALLEY CENTER
Practice Address - State:KS
Practice Address - Zip Code:67147-8413
Practice Address - Country:US
Practice Address - Phone:316-755-1130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-19
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-01304225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant