Provider Demographics
NPI:1851845812
Name:LUTZ, BRAD A (PTA)
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:A
Last Name:LUTZ
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:569 E BROAD ST
Mailing Address - Street 2:UNIT A
Mailing Address - City:SOUDERTON
Mailing Address - State:PA
Mailing Address - Zip Code:18964-1217
Mailing Address - Country:US
Mailing Address - Phone:215-421-2547
Mailing Address - Fax:
Practice Address - Street 1:250 N BETHLEHEM PIKE
Practice Address - Street 2:
Practice Address - City:AMBLER
Practice Address - State:PA
Practice Address - Zip Code:19002-3524
Practice Address - Country:US
Practice Address - Phone:215-421-2547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-08
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI003723225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant