Healthcare Provider Details

I. General information

NPI: 1275448490
Provider Name (Legal Business Name): BRANDON JAMES LUTTRELL DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 PINE RIDGE RD STE 201
NAPLES FL
34108-8913
US

IV. Provider business mailing address

6101 PINE RIDGE RD STE 101
NAPLES FL
34119-3900
US

V. Phone/Fax

Practice location:
  • Phone: 239-631-7008
  • Fax: 239-263-3957
Mailing address:
  • Phone: 239-449-3072
  • Fax: 877-334-1886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT45177
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: