Provider Demographics
NPI:1588148910
Name:LUNA, SUSAN ELIZABETH (PT, MS)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:ELIZABETH
Last Name:LUNA
Suffix:
Gender:F
Credentials:PT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2704 MAPLE LN
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-1074
Mailing Address - Country:US
Mailing Address - Phone:409-771-6903
Mailing Address - Fax:866-249-8575
Practice Address - Street 1:6059 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-7827
Practice Address - Country:US
Practice Address - Phone:409-771-6903
Practice Address - Fax:866-249-8575
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-21
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1116705225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1116705OtherPHYISCAL THERAPY LICENSE