Provider Demographics
NPI:1588472948
Name:LUITHLY PHYSICAL THERAPY INC
Entity type:Organization
Organization Name:LUITHLY PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:LUITHLY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, PT, OCS, CSCS
Authorized Official - Phone:949-981-2687
Mailing Address - Street 1:430 ENCLAVE CIR APT 303
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-8297
Mailing Address - Country:US
Mailing Address - Phone:949-981-2687
Mailing Address - Fax:
Practice Address - Street 1:430 ENCLAVE CIR APT 303
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-8297
Practice Address - Country:US
Practice Address - Phone:949-981-2687
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-18
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty