Provider Demographics
NPI:1306086368
Name:LUZ, MARVIN BAYLE (RPT)
Entity type:Individual
Prefix:
First Name:MARVIN
Middle Name:BAYLE
Last Name:LUZ
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7929 SAWYER RD
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:IL
Mailing Address - Zip Code:60561-5225
Mailing Address - Country:US
Mailing Address - Phone:630-325-5960
Mailing Address - Fax:
Practice Address - Street 1:600 THEODORE ST
Practice Address - Street 2:SUITE 4
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-2443
Practice Address - Country:US
Practice Address - Phone:815-724-0835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-03
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.016639225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist