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General NPI Number Information
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NPI Number | 1447454632
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Entity Type | Individual
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Provider Name | MATTHEW ALAN LUTHI ATC
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Gender | Male
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Dates
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Enumeration Date | 06/12/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 26427 STATE ROUTE 281
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City | DEFIANCE
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State | OH
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Zip | 43512-6781
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Country | US
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Telephone | 419-784-7594
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Fax |
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Provider Business Mailing Address
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Address Line | 741 DEERWOOD DR
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City | DEFIANCE
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State | OH
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Zip | 43512-6741
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Country | US
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Telephone | 419-782-5464
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Fax |
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT-002446
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License Number State | OH
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