Provider Demographics
NPI:1710522784
Name:VON DER LUFT, GRETA (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:GRETA
Middle Name:
Last Name:VON DER LUFT
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 DAVENPORT RD
Mailing Address - Street 2:
Mailing Address - City:MENDON
Mailing Address - State:MA
Mailing Address - Zip Code:01756-1083
Mailing Address - Country:US
Mailing Address - Phone:610-283-0839
Mailing Address - Fax:
Practice Address - Street 1:8 DAVENPORT RD
Practice Address - Street 2:
Practice Address - City:MENDON
Practice Address - State:MA
Practice Address - Zip Code:01756-1083
Practice Address - Country:US
Practice Address - Phone:610-283-0839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-13
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10164225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist