Provider Demographics
NPI:1104445485
Name:NERMAL, LUTHAR IAN URSAIZ (PT)
Entity type:Individual
Prefix:
First Name:LUTHAR IAN
Middle Name:URSAIZ
Last Name:NERMAL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7067 E ROBINSON AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93737-9214
Mailing Address - Country:US
Mailing Address - Phone:559-294-5988
Mailing Address - Fax:
Practice Address - Street 1:255 W FALLBROOK AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-6151
Practice Address - Country:US
Practice Address - Phone:559-840-1559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-16
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28837225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist