Provider Demographics
NPI:1245968957
Name:LUTZ, CAMERON (DPT)
Entity type:Individual
Prefix:DR
First Name:CAMERON
Middle Name:
Last Name:LUTZ
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12760 W 87TH STREET PKWY STE 108
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66215-2878
Mailing Address - Country:US
Mailing Address - Phone:913-379-9771
Mailing Address - Fax:
Practice Address - Street 1:3035 W MCMILLAN RD STE 104
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-6292
Practice Address - Country:US
Practice Address - Phone:208-887-8684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-8258225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist