Provider Demographics
NPI:1437778040
Name:LUETH, JON RAYMOND (PT)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:RAYMOND
Last Name:LUETH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6812 DEER HORN TRL NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52411-7795
Mailing Address - Country:US
Mailing Address - Phone:319-331-9816
Mailing Address - Fax:
Practice Address - Street 1:2701 PRAIRIE MEADOW DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-8001
Practice Address - Country:US
Practice Address - Phone:319-467-8220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-14
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA036022251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic