Provider Demographics
NPI:1265773956
Name:LUTTERODT, CHRISTIE ELAINE
Entity type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:ELAINE
Last Name:LUTTERODT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 WINTERPORT ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7845
Mailing Address - Country:US
Mailing Address - Phone:702-430-0281
Mailing Address - Fax:
Practice Address - Street 1:215 WINTERPORT ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7845
Practice Address - Country:US
Practice Address - Phone:702-430-0281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-06
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner