Active NPI
Mike Cris Bautista Luyun, PT
- Physical Therapist
- Philadelphia, PA
National Provider Identifier
1023313293
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT021093
- Practice address
- 1628 John F Kennedy Blvd
Suite 401
Philadelphia, PA 19103-2125 - Phone
- (215) 557-0057
- Fax
- (215) 557-0061
- NPI assigned
- Jan 20, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT021093 | PA | Primary |
Addresses
Primary practice location
1628 John F Kennedy Blvd
Suite 401
Philadelphia, PA 19103-2125
Mailing address
1628 John F Kennedy Blvd
Suite 401
Philadelphia, PA 19103-2125
Phone (215) 557-0057
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT021093 | PA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1295481600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1295481600000",
"number": "1023313293",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1628 JOHN F KENNEDY BLVD",
"address_2": "SUITE 401",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191032125",
"telephone_number": "215-557-0057",
"fax_number": "215-557-0061"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1628 JOHN F KENNEDY BLVD",
"address_2": "SUITE 401",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191032125",
"telephone_number": "215-557-0057",
"fax_number": "215-557-0061"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUYUN",
"first_name": "MIKE CRIS",
"middle_name": "BAUTISTA",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-01-20",
"last_updated": "2011-01-20",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "PA",
"license": "PT021093",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.