Provider Demographics
NPI:1538211974
Name:LUTHER, KARIN LYN (PT)
Entity type:Individual
Prefix:MS
First Name:KARIN
Middle Name:LYN
Last Name:LUTHER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 FIELDSTONE DR
Mailing Address - Street 2:APT 215
Mailing Address - City:WISCONSIN DELLS
Mailing Address - State:WI
Mailing Address - Zip Code:53965-8291
Mailing Address - Country:US
Mailing Address - Phone:608-393-7276
Mailing Address - Fax:608-524-9181
Practice Address - Street 1:300 RACE ST
Practice Address - Street 2:
Practice Address - City:WISCONSIN DELLS
Practice Address - State:WI
Practice Address - Zip Code:53965-1822
Practice Address - Country:US
Practice Address - Phone:608-524-7543
Practice Address - Fax:608-524-9181
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6475-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40381700Medicaid