Healthcare Provider Details

I. General information

NPI: 1659537207
Provider Name (Legal Business Name): LUKAS L TVEDT DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2008
Last Update Date: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12460 N RANCHO VISTOSO BLVD #140
ORO VALLEY AZ
85755-1982
US

IV. Provider business mailing address

408 HIGUERA ST STE 200
SAN LUIS OBISPO CA
93401-6135
US

V. Phone/Fax

Practice location:
  • Phone: 520-615-6573
  • Fax: 520-575-7014
Mailing address:
  • Phone: 805-788-0805
  • Fax: 805-788-0845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number8178
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: