Ethan Dale Luttrell

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

2019018423 Issued in MO

Practice address

302 E 4TH St
Eldon, MO 65026-1808

Phone

(573) 392-3000

NPI assigned

Jun 4, 2019

Last updated

Jun 4, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1559606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559606400000",
    "number": "1487212510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "302 E 4TH ST",
            "city": "ELDON",
            "state": "MO",
            "postal_code": "650261808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 E 4TH ST",
            "city": "ELDON",
            "state": "MO",
            "postal_code": "650261808",
            "telephone_number": "573-392-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUTTRELL",
        "first_name": "ETHAN",
        "middle_name": "DALE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-04",
        "last_updated": "2019-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MO",
            "license": "2019018423",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael James Lewis, FNP-BC
• Taylor Elizabeth Liska, LCSW
• Christine Ann Livek, M.D.
• Tiffany R Lucas, LPC
• Claire Luetkemeyer
• Malcolm J. Dickerson, M.D., P.C.
• Sidney Ann Mehrhoff, COTA/L
• Manuel L Mendez Jr., LCSW
• Lisa Ann Mertens, CPHT
• Joseph M Meystrik, FNP

• Physical Therapy Assistant in Eldon, MO
• Providers in Eldon, MO by specialty
• Physical Therapy Assistant in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.