Provider Demographics
NPI:1821690413
Name:LUTZ, DYLAN WOLFE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:DYLAN
Middle Name:WOLFE
Last Name:LUTZ
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5139 S YOSEMITE ST
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-3302
Mailing Address - Country:US
Mailing Address - Phone:303-284-3523
Mailing Address - Fax:303-997-4852
Practice Address - Street 1:5139 S YOSEMITE ST
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-3302
Practice Address - Country:US
Practice Address - Phone:303-284-3523
Practice Address - Fax:303-997-4852
Is Sole Proprietor?:No
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO17360225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist