Provider Demographics
NPI:1619546116
Name:LOZANO, LUKE RAY (PTA)
Entity Type:Individual
Prefix:MR
First Name:LUKE
Middle Name:RAY
Last Name:LOZANO
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5230 CARMELYNN ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-1906
Mailing Address - Country:US
Mailing Address - Phone:310-200-1246
Mailing Address - Fax:
Practice Address - Street 1:5230 CARMELYNN ST
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-1906
Practice Address - Country:US
Practice Address - Phone:310-200-1246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-21
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPTA48662225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant