Provider Demographics
NPI:1811016140
Name:LU, IRENE TAN (RPT)
Entity Type:Individual
Prefix:MRS
First Name:IRENE
Middle Name:TAN
Last Name:LU
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3749 CABALLERO AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34286-6966
Mailing Address - Country:US
Mailing Address - Phone:941-876-6888
Mailing Address - Fax:
Practice Address - Street 1:3749 CABALLERO AVE
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34286-6966
Practice Address - Country:US
Practice Address - Phone:941-876-6888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT20719225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist