Provider Demographics
NPI:1043073570
Name:LUTTRULL, ALAYNAH (LMT)
Entity type:Individual
Prefix:
First Name:ALAYNAH
Middle Name:
Last Name:LUTTRULL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 MARSHALL RD NE APT B
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-6220
Mailing Address - Country:US
Mailing Address - Phone:478-363-6273
Mailing Address - Fax:
Practice Address - Street 1:102 E CLINTON ST STE 3
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:GA
Practice Address - Zip Code:31032-5675
Practice Address - Country:US
Practice Address - Phone:478-363-6273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT014740225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist