Provider Demographics
NPI:1134632748
Name:LUNDY, NANCY LOUISE (PTA)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:LOUISE
Last Name:LUNDY
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:PO BOX 2256
Mailing Address - Street 2:
Mailing Address - City:ALBRIGHTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18210-2256
Mailing Address - Country:US
Mailing Address - Phone:570-215-4215
Mailing Address - Fax:
Practice Address - Street 1:370 WHITESTONE COR
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-7193
Practice Address - Country:US
Practice Address - Phone:570-476-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-06
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI002702225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PATEI002702OtherLICENSE NUMBER