MEDICARE: ADAMILEY LUNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	2098155	TX

General Provider Information

NPI Number	:	1467860866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADAMILEY LUNA

Provider Business Mailing Address
First Line	:	1300 N VIRGINIA ST
Second Line	:
City	:	PORT LAVACA
State	:	TX
Zip	:	77979-2509
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 N VIRGINIA ST
Second Line	:
City	:	PORT LAVACA
State	:	TX
Zip	:	77979-2509
Country	:	US
Telephone Number	:	361-551-2513
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2014
Last Update Date	:	07/29/2014

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Directions to “ ADAMILEY LUNA ” Practice Location

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