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 1:525 TYLER RD STE I
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-3363
Mailing Address - Country:US
Mailing Address - Phone:630-584-2070
Mailing Address - Fax:630-584-0520
Practice Address - Street 1:525 TYLER RD STE I
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-3363
Practice Address - Country:US
Practice Address - Phone:630-568-6123
Practice Address - Fax:630-584-0520
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-21
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070010359261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy