Healthcare Provider Details

I. General information

NPI: 1790800282
Provider Name (Legal Business Name): ANNE-MARIE LUCHANSKY LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 MCCLURG RD
BOARDMAN OH
44512-6737
US

IV. Provider business mailing address

7037 KILLDEER DR
CANFIELD OH
44406-9181
US

V. Phone/Fax

Practice location:
  • Phone: 330-729-1440
  • Fax:
Mailing address:
  • Phone: 330-533-1378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number666
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: