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Individual

MISS LISA MARIE UTT

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PTA

Contact information

Practice address
5156 WHIPPLE AVE NW, CANTON, OH 44718-2663
(330) 478-1752
(330) 478-1763
Mailing address
5156 WHIPPLE AVE NW, CANTON, OH 44718-2663
(330) 478-1752
(330) 478-1763

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA-08117
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
3055563
OH
Enumeration date
09/06/2011
Last updated
09/06/2011
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