Provider Demographics
NPI:1740387414
Name:LUISTRO, ZIRNA B (DPT)
Entity Type:Individual
Prefix:
First Name:ZIRNA
Middle Name:B
Last Name:LUISTRO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 ALTON PARKWAY
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-1808
Mailing Address - Country:US
Mailing Address - Phone:949-932-2960
Mailing Address - Fax:714-748-6313
Practice Address - Street 1:6400 ALTON PARKWAY
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-8853
Practice Address - Country:US
Practice Address - Phone:949-932-2960
Practice Address - Fax:714-748-6313
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 27090225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT 27090Medicare ID - Type UnspecifiedPPIN