Provider Demographics
NPI:1386673846
Name:LUTZ, KELLEY LYNN (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:KELLEY
Middle Name:LYNN
Last Name:LUTZ
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:30 PECK RD
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-6123
Mailing Address - Country:US
Mailing Address - Phone:860-489-0867
Mailing Address - Fax:860-489-4473
Practice Address - Street 1:30 PECK RD
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-6123
Practice Address - Country:US
Practice Address - Phone:860-489-0867
Practice Address - Fax:860-489-4473
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006578225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist