MEDICARE: MS. JENNIFER E LUTZ MPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT08968	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000561960	OTHER		ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073580155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER E LUTZ MPT

Provider Business Mailing Address
First Line	:	108 GLOVER DR.
Second Line	:
City	:	MT. ORAB
State	:	OH
Zip	:	45154
Country	:	US
Telephone Number	:	937-444-2933
Fax Number	:	937-444-2924

Provider Business Practice Location Address
First Line	:	108 GLOVER DR
Second Line	:
City	:	MOUNT ORAB
State	:	OH
Zip	:	45154-8390
Country	:	US
Telephone Number	:	937-444-2933
Fax Number	:	937-444-2924

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2006
Last Update Date	:	09/19/2011

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