Healthcare Provider Details

I. General information

NPI: 1639955388
Provider Name (Legal Business Name): DANNY L LUKENS PHYSICAL THERAPIST P
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2023
Last Update Date: 09/22/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 W NEW RD
GREENFIELD IN
46140-7304
US

IV. Provider business mailing address

801 N STATE ST
GREENFIELD IN
46140-1270
US

V. Phone/Fax

Practice location:
  • Phone: 317-468-6100
  • Fax: 317-468-6122
Mailing address:
  • Phone: 317-462-5544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05005345A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: