Individual provider Active NPI

Jared Anthony Lutz, DPT

  • Physical Therapist
  • Prior Lake, MN
National Provider Identifier
1194973891
Registry record updated Mar 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
8449 Issued in MN
Practice address
19400 Normandale Rd
Prior Lake, MN 55372-9764
Phone
(612) 968-0094
NPI assigned
Sep 5, 2008
Last updated
Mar 17, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 11079-24 WI
Physical Therapist 225100000X 8449 MN Primary

Addresses

Primary practice location

19400 Normandale Rd
Prior Lake, MN 55372-9764

Mailing address

19400 Normandale Rd
Prior Lake, MN 55372-9764
Phone (612) 968-0094

Other practice location 1

7900 W 78th St Ste 180
Edina, MN 55439-2537
Phone (612) 968-0094

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100514000547 MN Practitioner - Physical Therapist in Private Practice 8729147566 Practice locations: Prior Lake, MN

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
11079-24WIMDPhysical Therapist
8449MNMDAudiologist-Hearing Aid Fitter

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1220572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742169600000",
    "number": "1194973891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19400 NORMANDALE RD",
            "city": "PRIOR LAKE",
            "state": "MN",
            "postal_code": "553729764",
            "telephone_number": "612-968-0094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19400 NORMANDALE RD",
            "city": "PRIOR LAKE",
            "state": "MN",
            "postal_code": "553729764",
            "telephone_number": "612-968-0094"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7900 W 78th St Ste 180",
            "address_purpose": "LOCATION",
            "city": "Edina",
            "state": "MN",
            "postal_code": "554392537",
            "country_code": "US",
            "telephone_number": "612-968-0094",
            "fax_number": "612-968-0094",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LUTZ",
        "first_name": "JARED",
        "middle_name": "ANTHONY",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-09-05",
        "last_updated": "2025-03-17",
        "certification_date": "2025-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "11079-24",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "8449",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Prior Lake, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.