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Individual

FRED LUSTER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MPT

Contact information

Practice address
3221 BEACON PKWY STE 100, GRANGER, IN 46530
(574) 647-2930
(574) 647-2935
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05006770A
IN

Other

Enumeration date
11/26/2016
Last updated
03/30/2021
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