Provider Demographics
NPI:1023313293
Name:LUYUN, MIKE CRIS BAUTISTA (PT)
Entity type:Individual
Prefix:
First Name:MIKE CRIS
Middle Name:BAUTISTA
Last Name:LUYUN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1628 JOHN F KENNEDY BLVD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-2125
Mailing Address - Country:US
Mailing Address - Phone:215-557-0057
Mailing Address - Fax:215-557-0061
Practice Address - Street 1:1628 JOHN F KENNEDY BLVD
Practice Address - Street 2:SUITE 401
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-2125
Practice Address - Country:US
Practice Address - Phone:215-557-0057
Practice Address - Fax:215-557-0061
Is Sole Proprietor?:No
Enumeration Date:2011-01-20
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT021093225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist