Healthcare Provider Details

I. General information

NPI: 1992370050
Provider Name (Legal Business Name): THERESA MARIE LUCHT RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2021
Last Update Date: 05/21/2021
Certification Date: 05/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 32ND AVE S
FARGO ND
58103-6132
US

IV. Provider business mailing address

1482 W GATEWAY CICLE S
FARGO ND
58103
US

V. Phone/Fax

Practice location:
  • Phone: 701-364-8185
  • Fax:
Mailing address:
  • Phone: 701-659-0176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberR-1070
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: