Provider Demographics
NPI:1003193616
Name:LUNA, ROYLEE (DPT)
Entity Type:Individual
Prefix:
First Name:ROYLEE
Middle Name:
Last Name:LUNA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4411 MONTANO RD NW
Mailing Address - Street 2:SUITE F
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-3235
Mailing Address - Country:US
Mailing Address - Phone:505-838-8900
Mailing Address - Fax:505-838-8313
Practice Address - Street 1:4411 MONTANO RD NW
Practice Address - Street 2:SUITE F
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-3235
Practice Address - Country:US
Practice Address - Phone:505-838-8900
Practice Address - Fax:505-838-8313
Is Sole Proprietor?:No
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4061225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist