Provider Demographics
NPI:1043425127
Name:LUZ, BERNADETTE (PT)
Entity Type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:
Last Name:LUZ
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 1:18901 BRAEMORE RD
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91326-1131
Mailing Address - Country:US
Mailing Address - Phone:818-800-0124
Mailing Address - Fax:818-337-7165
Practice Address - Street 1:18901 BRAEMORE RD
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91326-1131
Practice Address - Country:US
Practice Address - Phone:818-800-0124
Practice Address - Fax:818-337-7165
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT24257225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist