Individual
DI LUO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
8509 HOSPITAL DR, DOUGLASVILLE, GA 30134-2414
(678) 431-0628
Mailing address
227 ROCKY RIDGE BLVD, DOUGLASVILLE, GA 30134-1521
(678) 431-0628
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT014099
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT014099
GEORGIA STATE BOARD OF PHYSICAL THERAPY
GA
Enumeration date
07/11/2019
Last updated
07/11/2019
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