Healthcare Provider Details

I. General information

NPI: 1326296484
Provider Name (Legal Business Name): MARIA CARMELA DE LUNA DPT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2008
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30940 STAGECOACH BLVD # 110
EVERGREEN CO
80439-7984
US

IV. Provider business mailing address

15202 HONSENA DR
CENTREVILLE VA
20120-1420
US

V. Phone/Fax

Practice location:
  • Phone: 303-674-1594
  • Fax: 303-674-9870
Mailing address:
  • Phone: 732-207-1242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number309524
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL.0011519
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number24232
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305207196
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: