Provider Demographics
NPI:1760651467
Name:LUTZ, RENEE A M (RPT, CST)
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:A M
Last Name:LUTZ
Suffix:
Gender:F
Credentials:RPT, CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11047 FAIRHAVEN WAY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-7111
Mailing Address - Country:US
Mailing Address - Phone:407-275-7155
Mailing Address - Fax:
Practice Address - Street 1:11047 FAIRHAVEN WAY
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-7111
Practice Address - Country:US
Practice Address - Phone:407-275-7155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 7202225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT 7202OtherDEPARTMENT OF HEALTH