Provider Demographics
NPI:1689128431
Name:LUERS, MATTHEW (AT,C)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:LUERS
Suffix:
Gender:M
Credentials:AT,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5670 LANCEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-6340
Mailing Address - Country:US
Mailing Address - Phone:386-314-7955
Mailing Address - Fax:
Practice Address - Street 1:640 DR MARY MCLEOD BETHUNE BLVD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-3012
Practice Address - Country:US
Practice Address - Phone:386-481-2261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer