MEDICARE: TOBIAS DE LUCA

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	225200000X	Physical Therapy Assistant	A-0335	NV

General Provider Information

NPI Number	:	1356516694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TOBIAS DE LUCA

Provider Business Mailing Address
First Line	:	1015 BAILY CT
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89703-7335
Country	:	US
Telephone Number	:	775-544-5822
Fax Number	:

Provider Business Practice Location Address
First Line	:	1015 BAILY CT
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89703-7335
Country	:	US
Telephone Number	:	775-544-5822
Fax Number	:

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

Provider Enumeration Date	:	04/28/2008
Last Update Date	:	04/28/2008

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Directions to “ TOBIAS DE LUCA ” Practice Location

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