Healthcare Provider Details

I. General information

NPI: 1811579063
Provider Name (Legal Business Name): ERIC LUKKEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2021
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5320 MARK DABLING BLVD STE 100
COLORADO SPRINGS CO
80918-3839
US

IV. Provider business mailing address

10838 FOSSIL DUST DR
COLORADO SPRINGS CO
80908-7005
US

V. Phone/Fax

Practice location:
  • Phone: 719-592-1584
  • Fax:
Mailing address:
  • Phone: 719-359-0139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: