Individual provider Active NPI

Bryant L Lutz, DPT

  • Physical Therapist
  • Manassas, VA
National Provider Identifier
1356587166
Registry record updated Nov 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
2305205600 Issued in VA
Practice address
8140 Ashton Ave
Suite 104
Manassas, VA 20109-5698
Phone
(703) 257-3333
Fax
(703) 257-0066
NPI assigned
Dec 29, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 2305205600 VA Primary

Addresses

Primary practice location

8140 Ashton Ave
Suite 104
Manassas, VA 20109-5698

Mailing address

PO Box 1769
Middleburg, VA 20118-1769
Phone (540) 687-8181

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, VA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20090203000056 DC Practitioner - Physical Therapist in Private Practice 6507920741 Reassigns benefits to 1 organization
I20090203000610 VA Practitioner - Physical Therapist in Private Practice 6507920741 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jackson Clinics Limited PartnershipGroup PAC ID 2860623295, 116 clinicians

Practice addresses (Care Compare)

8140 Ashton Ave
Suite 104
Manassas, VA 20109-5699
Phone (703) 257-3333

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Jackson Clinics Limited Partnership Physical Therapist CurrentSince May 1, 2014 Accepting new patients

Locations

43490 Yukon Dr
Ashburn, VA 20147
Phone (703) 729-7920

43490 Yukon Dr
Ste 212
Ashburn, VA 20147
Phone (703) 729-7920

12701 Fair Lakes Cir
Ste 102
Fairfax, VA 22033

5115 Leesburg Pike
Falls Church, VA 22041
Phone (703) 253-0022

8140 Ashton Ave
Ste 104
Manassas, VA 20109
Phone (703) 257-3333

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1230508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731628800000",
    "number": "1356587166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1769",
            "city": "MIDDLEBURG",
            "state": "VA",
            "postal_code": "201181769",
            "telephone_number": "540-687-8181",
            "fax_number": "540-687-8256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8140 ASHTON AVE",
            "address_2": "SUITE 104",
            "city": "MANASSAS",
            "state": "VA",
            "postal_code": "201095698",
            "telephone_number": "703-257-3333",
            "fax_number": "703-257-0066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUTZ",
        "first_name": "BRYANT",
        "middle_name": "L",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-12-29",
        "last_updated": "2024-11-15",
        "certification_date": "2024-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305205600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Manassas, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.