Provider Demographics
NPI:1861661050
Name:NINO, LUNA X (PT)
Entity Type:Individual
Prefix:
First Name:LUNA
Middle Name:X
Last Name:NINO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1174 S SCOVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60304-2140
Mailing Address - Country:US
Mailing Address - Phone:708-386-0862
Mailing Address - Fax:708-386-0862
Practice Address - Street 1:1174 S SCOVILLE AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60304-2140
Practice Address - Country:US
Practice Address - Phone:708-386-0862
Practice Address - Fax:708-386-0862
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-21
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation