Healthcare Provider Details

I. General information

NPI: 1013759299
Provider Name (Legal Business Name): AVERY CLUKEY PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2024
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HIGHLANDS DR STE 100
LITITZ PA
17543-7692
US

IV. Provider business mailing address

100 HIGHLANDS DR STE 100
LITITZ PA
17543-7692
US

V. Phone/Fax

Practice location:
  • Phone: 717-625-2228
  • Fax: 717-625-0959
Mailing address:
  • Phone: 717-625-2228
  • Fax: 717-625-0959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT034334
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: