Provider Demographics
NPI:1942320874
Name:LUTZ, WILLIAM THOMAS JR (PT)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:THOMAS
Last Name:LUTZ
Suffix:JR
Gender:M
Credentials:PT
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Mailing Address - Street 1:1101 OHIO DR
Mailing Address - Street 2:STE 105
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5331
Mailing Address - Country:US
Mailing Address - Phone:972-420-6605
Mailing Address - Fax:972-436-2770
Practice Address - Street 1:966 N GARDEN RIDGE BLVD STE 530
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75077-2876
Practice Address - Country:US
Practice Address - Phone:972-420-6605
Practice Address - Fax:972-436-2770
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1034239225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T1320OtherBCBS
TX7805686OtherAETNA PROVIDER NUMBER
TX7369407OtherBCBS BLUELINK
TX8T1320OtherBCBS