Individual
JASON LUTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
205 S PROVIDENCE RD, WALLINGFORD, PA 19086-6333
(610) 310-7690
Mailing address
23 SANDY LN, MALVERN, PA 19355-3027
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
PA
Other
Enumeration date
09/05/2013
Last updated
09/05/2013
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