Provider Demographics
NPI:1477999019
Name:LUNA, GLENN ACAS (PT)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:ACAS
Last Name:LUNA
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 1:111 E MOSHOLU PKWY N APT 3A
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-2913
Mailing Address - Country:US
Mailing Address - Phone:646-379-9180
Mailing Address - Fax:
Practice Address - Street 1:3227 E TREMONT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-5707
Practice Address - Country:US
Practice Address - Phone:718-904-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019151225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist