MEDICARE: LUKE LETTINGA

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	291530	CA

General Provider Information

NPI Number	:	1255721015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUKE LETTINGA

Provider Business Mailing Address
First Line	:	108 HOLLY WAY
Second Line	:
City	:	PISMO BEACH
State	:	CA
Zip	:	93449-3221
Country	:	US
Telephone Number	:	616-560-8671
Fax Number	:

Provider Business Practice Location Address
First Line	:	108 HOLLY WAY
Second Line	:
City	:	PISMO BEACH
State	:	CA
Zip	:	93449-3221
Country	:	US
Telephone Number	:	616-560-8671
Fax Number	:

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

Provider Enumeration Date	:	02/02/2015
Last Update Date	:	03/02/2026

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Directions to “ LUKE LETTINGA ” Practice Location

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