Healthcare Provider Details

I. General information

NPI: 1578109583
Provider Name (Legal Business Name): LUIS FERNANDO LOBO PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2019
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2940 E BANNER GATEWAY DR STE 200-250
GILBERT AZ
85234-2168
US

IV. Provider business mailing address

PO BOX 80217
PHOENIX AZ
85060-0217
US

V. Phone/Fax

Practice location:
  • Phone: 602-648-5444
  • Fax: 602-772-3801
Mailing address:
  • Phone: 602-385-2115
  • Fax: 480-418-3323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number30974
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: