Provider Demographics
NPI:1215436944
Name:LUNA, JUSTIN JOSEPH (PT)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:JOSEPH
Last Name:LUNA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3421 ARLINGTON AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-3254
Mailing Address - Country:US
Mailing Address - Phone:951-684-2865
Mailing Address - Fax:951-934-0555
Practice Address - Street 1:3421 ARLINGTON AVE STE 105
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-3254
Practice Address - Country:US
Practice Address - Phone:951-684-2865
Practice Address - Fax:951-934-0555
Is Sole Proprietor?:No
Enumeration Date:2018-02-08
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT294338225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist