Provider Demographics
NPI:1740315662
Name:LUTZ, ANDREA MARIE (PT)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:MARIE
Last Name:LUTZ
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 1:947 E OAKVIEW ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-6482
Mailing Address - Country:US
Mailing Address - Phone:913-945-0117
Mailing Address - Fax:
Practice Address - Street 1:5211 W 103RD ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66207-3154
Practice Address - Country:US
Practice Address - Phone:913-383-2569
Practice Address - Fax:913-383-2611
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1104168225100000X
MO2011002607225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist