Healthcare Provider Details

I. General information

NPI: 1659450526
Provider Name (Legal Business Name): LYNN M LUKINS LPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

982 EASTERN PARKWAY
LOUISVILLE KY
40217
US

IV. Provider business mailing address

1262 EVERETT AVE
LOUISVILLE KY
40204
US

V. Phone/Fax

Practice location:
  • Phone: 502-635-6397
  • Fax: 502-635-1147
Mailing address:
  • Phone: 502-458-5668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number000844
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: