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General NPI Number Information
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NPI Number | 1366073553
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Entity Type | Individual
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Provider Name | ANNA MARIA LUKASIK PT
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Gender | Female
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Dates
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Enumeration Date | 01/28/2020
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Last Update Date | 01/28/2020
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Provider Practice Location Address
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Address Line | 863 RIDGEVIE TERRACE
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City | FREMONT
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State | CA
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Zip | 94539
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Country | US
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Telephone | 510-396-1603
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Fax |
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Provider Business Mailing Address
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Address Line | 2080 CLARK AVE
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City | SANTA CLARA
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State | CA
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Zip | 95051-1807
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Country | US
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Telephone | 916-248-0797
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT291478
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License Number State | CA
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