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NPI Code Detail

MEDICARE: MATTHEW LUERS A.T.,C.

MEDICARE: MATTHEW LUERS A.T.,C.
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
12255A2300XAthletic Trainer

General Provider Information

NPI Number : 1689128431
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW LUERS A.T.,C.
Provider Business Mailing Address
First Line : 5670 LANCEWOOD DR
Second Line :
City : PORT ORANGE
State : FL
Zip : 32127-6340
Country : US
Telephone Number : 386-314-7955
Fax Number :
Provider Business Practice Location Address
First Line : 640 DR MARY MCLEOD BETHUNE BLVD
Second Line :
City : DAYTONA BEACH
State : FL
Zip : 32114-3012
Country : US
Telephone Number : 386-481-2261
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2016
Last Update Date : 08/10/2016

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