Individual
EMMANUEL LUNA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
701 SAINT LOUIS AVE, FORT WORTH, TX 76104
(817) 336-9962
Mailing address
701 SAINT LOUIS AVE, FORT WORTH, TX 76104-3324
(817) 332-9962
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
212771
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2127711
—
TX
Enumeration date
08/29/2018
Last updated
08/29/2018
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