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General NPI Number Information
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NPI Number | 1588472948
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Entity Type | Organization
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Legal Business Name | LUITHLY PHYSICAL THERAPY INC
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Dates
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Enumeration Date | 12/18/2024
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Last Update Date | 12/30/2024
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Provider Practice Location Address
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Address Line | 430 ENCLAVE CIR APT 303
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City | COSTA MESA
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State | CA
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Zip | 92626-8297
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Country | US
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Telephone | 949-981-2687
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Fax |
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Provider Business Mailing Address
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Address Line | 430 ENCLAVE CIR APT 303
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City | COSTA MESA
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State | CA
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Zip | 92626-8297
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Country | US
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Telephone | 949-981-2687
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Fax |
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Authorized Official
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Title or Position | OWNER/ PHYSICAL THERAPIST
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Name | DR. BRYAN JAMES LUITHLY
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Credential | DPT, PT, OCS, CSCS
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Telephone | 949-981-2687
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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 |
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License Number State |
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