Provider Demographics
NPI:1275583569
Name:LUNA, IVAN (MPT, CSCS)
Entity Type:Individual
Prefix:
First Name:IVAN
Middle Name:
Last Name:LUNA
Suffix:
Gender:M
Credentials:MPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 COIT RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-3768
Mailing Address - Country:US
Mailing Address - Phone:469-467-8705
Mailing Address - Fax:267-321-2550
Practice Address - Street 1:135 BUNTON CREEK RD
Practice Address - Street 2:SUITE 303
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-5787
Practice Address - Country:US
Practice Address - Phone:512-268-4700
Practice Address - Fax:512-268-4703
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7610225100000X
TX1122232225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX893T07OtherBCBS
TX00636YMedicare PIN
TX304809YLHEMedicare PIN
TX304809YT6UMedicare PIN
TX00X553Medicare PIN