Provider Demographics
NPI:1790992378
Name:LUTZ, WILLIAM SCOTT (ARNP, PT)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:SCOTT
Last Name:LUTZ
Suffix:
Gender:M
Credentials:ARNP, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1926 CRESCENT BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-4609
Mailing Address - Country:US
Mailing Address - Phone:407-227-0359
Mailing Address - Fax:
Practice Address - Street 1:1926 CRESCENT BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-4609
Practice Address - Country:US
Practice Address - Phone:407-227-0359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9196918363L00000X
FLPT22471225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP9196918OtherMEIDCAL LICENSE
FL004358700Medicaid
FL004358700Medicaid