MEDICARE: DR. JUDI A. LUTTIERI DPT

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	017538	NY

General Provider Information

NPI Number	:	1760633598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUDI A. LUTTIERI DPT

Provider Business Mailing Address
First Line	:	975 STEWART AVE
Second Line	:
City	:	GARDEN CITY
State	:	NY
Zip	:	11530-4816
Country	:	US
Telephone Number	:	516-222-8654
Fax Number	:	516-745-5476

Provider Business Practice Location Address
First Line	:	711 STEWART AVE
Second Line	:
City	:	GARDEN CITY
State	:	NY
Zip	:	11530-4731
Country	:	US
Telephone Number	:	516-222-8654
Fax Number	:	516-745-5476

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

Provider Enumeration Date	:	10/10/2008
Last Update Date	:	03/10/2011

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