Healthcare Provider Details

I. General information

NPI: 1174354468
Provider Name (Legal Business Name): NICOLE ANNA LUKINBEAL PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2024
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 QUAIL LAKE LOOP STE 100
COLORADO SPRINGS CO
80906-4651
US

IV. Provider business mailing address

680 WELSH CIR
COLORADO SPRINGS CO
80916-3997
US

V. Phone/Fax

Practice location:
  • Phone: 719-579-0230
  • Fax:
Mailing address:
  • Phone: 813-613-1883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL.0020512
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT42071
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT42071
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: