Provider Demographics
NPI:1982009734
Name:LUITHLY, BRYAN JAMES (PT, DPT, OCS, CSCS)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:JAMES
Last Name:LUITHLY
Suffix:
Gender:M
Credentials:PT, DPT, OCS, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:
Is Sole Proprietor?:No
Enumeration Date:2014-10-22
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41056225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist