Healthcare Provider Details

I. General information

NPI: 1518073733
Provider Name (Legal Business Name): DAVID R. LUTZ PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N US HIGHWAY 89
PRESCOTT AZ
86313-5001
US

IV. Provider business mailing address

531 MESA DR
PRESCOTT AZ
86303-4129
US

V. Phone/Fax

Practice location:
  • Phone: 928-717-7493
  • Fax: 928-776-6172
Mailing address:
  • Phone: 928-442-2337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1807
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: