Provider Demographics
NPI:1225584105
Name:LUU, JONATHAN VAN (DPT)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:VAN
Last Name:LUU
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 1:3070 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-2310
Mailing Address - Country:US
Mailing Address - Phone:760-591-7750
Mailing Address - Fax:760-471-5139
Practice Address - Street 1:935 W SAN MARCOS BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-1142
Practice Address - Country:US
Practice Address - Phone:760-471-2440
Practice Address - Fax:760-471-2442
Is Sole Proprietor?:No
Enumeration Date:2016-08-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT291881225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist