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General NPI Number Information
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NPI Number | 1548374473
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Entity Type | Organization
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Legal Business Name | LB PHYSICAL THERAPY INC.
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 02/04/2011
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Provider Practice Location Address
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Address Line | 2800 NILES RD
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City | SAINT JOSEPH
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State | MI
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Zip | 49085-3317
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Country | US
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Telephone | 269-408-1944
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Fax | 269-408-1946
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Provider Business Mailing Address
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Address Line | 2746 SANCTUARY DR
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City | STEVENSVILLE
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State | MI
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Zip | 49127-8313
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Country | US
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Telephone | 269-408-1990
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Fax | 269-408-1993
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Authorized Official
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Title or Position | OWNER
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Name | PIERRE A LUYCKX
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Credential | DPT
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Telephone | 269-556-0881
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501007604
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License Number State | MI
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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 | 5501008773
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License Number State | MI
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