Provider Demographics
NPI:1396055901
Name:FOLTZ, LISA SUANN (PTA)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:SUANN
Last Name:FOLTZ
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2302 MEADOWLARK TERR
Mailing Address - Street 2:
Mailing Address - City:EUDORA
Mailing Address - State:KS
Mailing Address - Zip Code:66025
Mailing Address - Country:US
Mailing Address - Phone:785-542-1598
Mailing Address - Fax:
Practice Address - Street 1:924 LOCUST
Practice Address - Street 2:
Practice Address - City:EUDORA
Practice Address - State:KS
Practice Address - Zip Code:66025
Practice Address - Country:US
Practice Address - Phone:785-542-3333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-01278225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant