Provider Demographics
NPI:1962711440
Name:LEGUA, LUAR ARJAY DU (PT)
Entity type:Individual
Prefix:
First Name:LUAR ARJAY
Middle Name:DU
Last Name:LEGUA
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 1:4716 176TH ST SW
Mailing Address - Street 2:APT C1
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037-3465
Mailing Address - Country:US
Mailing Address - Phone:719-250-7706
Mailing Address - Fax:
Practice Address - Street 1:1208 LUTHER ST
Practice Address - Street 2:
Practice Address - City:EADS
Practice Address - State:CO
Practice Address - Zip Code:81036-0817
Practice Address - Country:US
Practice Address - Phone:719-438-5401
Practice Address - Fax:719-438-5391
Is Sole Proprietor?:No
Enumeration Date:2010-09-30
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL-8449225100000X
WAPT00010660225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist