Provider Demographics
NPI:1750576575
Name:DEJULIUS, LUANN LYNN (PT)
Entity type:Individual
Prefix:MRS
First Name:LUANN
Middle Name:LYNN
Last Name:DEJULIUS
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 1:34600 CHARDON RD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-8480
Mailing Address - Country:US
Mailing Address - Phone:440-461-3127
Mailing Address - Fax:
Practice Address - Street 1:34600 CHARDON RD
Practice Address - Street 2:SUITE 9
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-8480
Practice Address - Country:US
Practice Address - Phone:440-461-3127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-14
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0050972251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4150213Medicare PIN