Provider Demographics
NPI:1083707368
Name:LUTZ, HELEN B (RN, LMT)
Entity Type:Individual
Prefix:
First Name:HELEN
Middle Name:B
Last Name:LUTZ
Suffix:
Gender:F
Credentials:RN, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 MELWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-4277
Mailing Address - Country:US
Mailing Address - Phone:585-733-1971
Mailing Address - Fax:440-848-1878
Practice Address - Street 1:3380 MONROE AVE
Practice Address - Street 2:SUITE 215
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-4726
Practice Address - Country:US
Practice Address - Phone:585-733-1971
Practice Address - Fax:440-848-1878
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-01
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013085-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1107599OtherAMERICAN SPECIALTY HEALTH
NYMNY308BOtherLANDMARK HEALTHCARE, INC., MVP HEALTH PLAN