Healthcare Provider Details

I. General information

NPI: 1669048088
Provider Name (Legal Business Name): DR. GREGORY THOMAS LUTZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2021
Last Update Date: 05/27/2021
Certification Date: 05/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 S 20TH ST
PURCELLVILLE VA
20132-3301
US

IV. Provider business mailing address

1211 FEATHERSTONE LN NE
LEESBURG VA
20176-4915
US

V. Phone/Fax

Practice location:
  • Phone: 571-363-2753
  • Fax:
Mailing address:
  • Phone: 412-726-9253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305207707
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: