Provider Demographics
NPI:1902125214
Name:LUNA, COURTNEY F (PT)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:F
Last Name:LUNA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:F
Other - Last Name:LEESER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:117 E 19TH ST
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-5151
Mailing Address - Country:US
Mailing Address - Phone:575-625-3372
Mailing Address - Fax:575-625-3303
Practice Address - Street 1:117 E 19TH ST
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-5151
Practice Address - Country:US
Practice Address - Phone:575-625-3372
Practice Address - Fax:575-625-3303
Is Sole Proprietor?:No
Enumeration Date:2010-05-26
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3958225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist