Provider Demographics
NPI:1275079345
Name:LUTHER, GENEVIEVE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:GENEVIEVE
Middle Name:
Last Name:LUTHER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:GENEVIEVE
Other - Middle Name:
Other - Last Name:LEBBIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:250 E DAY RD
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-3471
Mailing Address - Country:US
Mailing Address - Phone:574-247-8700
Mailing Address - Fax:
Practice Address - Street 1:250 E DAY RD
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-3471
Practice Address - Country:US
Practice Address - Phone:574-247-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-13
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05008751A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist