Provider Demographics
NPI:1407125727
Name:LUXENBERG, DAVID (PT, DPT, CSCS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:LUXENBERG
Suffix:
Gender:M
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 ORANGE BLOSSOM CIR
Mailing Address - Street 2:
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694-1250
Mailing Address - Country:US
Mailing Address - Phone:949-683-1661
Mailing Address - Fax:
Practice Address - Street 1:14 ORANGE BLOSSOM CIR
Practice Address - Street 2:
Practice Address - City:LADERA RANCH
Practice Address - State:CA
Practice Address - Zip Code:92694-1250
Practice Address - Country:US
Practice Address - Phone:949-683-1661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-15
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38419225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist