Provider Demographics
NPI:1417297193
Name:DEL PILAR, LUTHGARDA STA MARIA (PT)
Entity Type:Individual
Prefix:
First Name:LUTHGARDA
Middle Name:STA MARIA
Last Name:DEL PILAR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221-A 7TH STREET
Mailing Address - Street 2:
Mailing Address - City:PORT ST. JOE
Mailing Address - State:FL
Mailing Address - Zip Code:32456-5318
Mailing Address - Country:US
Mailing Address - Phone:850-774-8429
Mailing Address - Fax:850-227-7999
Practice Address - Street 1:3801 E HIGHWAY 98
Practice Address - Street 2:SUITE 100
Practice Address - City:PORT ST JOE
Practice Address - State:FL
Practice Address - Zip Code:32456-5318
Practice Address - Country:US
Practice Address - Phone:850-229-5752
Practice Address - Fax:850-227-7999
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-18
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT27432225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002012700Medicaid
FL100313Medicare UPIN