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General NPI Number Information
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NPI Number | 1275583569
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Entity Type | Individual
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Provider Name | IVAN LUNA MPT, CSCS
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Gender | Male
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Dates
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Enumeration Date | 05/10/2006
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Last Update Date | 12/02/2013
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Provider Practice Location Address
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Address Line | 135 BUNTON CREEK RD SUITE 303
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City | KYLE
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State | TX
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Zip | 78640-5787
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Country | US
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Telephone | 512-268-4700
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Fax | 512-268-4703
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Provider Business Mailing Address
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Address Line | 2300 COIT RD SUITE 300
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City | PLANO
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State | TX
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Zip | 75075-3768
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Country | US
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Telephone | 469-467-8705
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Fax | 267-321-2550
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 7610
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1122232
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License Number State | TX
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