Provider Demographics
NPI:1629310271
Name:LUTZE, KAREN LOUISE
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:LOUISE
Last Name:LUTZE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5
Mailing Address - Street 2:404 PARRISH ROAD
Mailing Address - City:TECOPA
Mailing Address - State:CA
Mailing Address - Zip Code:92389-0005
Mailing Address - Country:US
Mailing Address - Phone:760-852-4381
Mailing Address - Fax:760-852-4381
Practice Address - Street 1:404 PARRISH ROAD
Practice Address - Street 2:
Practice Address - City:TECOPA
Practice Address - State:CA
Practice Address - Zip Code:92389-0005
Practice Address - Country:US
Practice Address - Phone:760-852-4381
Practice Address - Fax:760-852-4381
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-21
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner