Individual
MIA ANTIONETTTE LUTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPTA
Contact information
Practice address
1560 SUMRALL RD, COLUMBIA, MS 39429-2654
(601) 740-2031
Mailing address
33 CHARLIES LN, COLUMBIA, MS 39429-9291
(601) 731-4972
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA4080
MS
Other
Enumeration date
03/29/2007
Last updated
07/08/2007
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