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NPI Code Detail

MEDICARE: JAIMIE LYNN LUECKE PT, DPT

MEDICARE: JAIMIE LYNN LUECKE PT, DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistPT017948OH

General Provider Information

NPI Number : 1437869104
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAIMIE LYNN LUECKE PT, DPT
Provider Business Mailing Address
First Line : 1236 EASTWOOD CIR SE
Second Line :
City : NORTH CANTON
State : OH
Zip : 44720-4372
Country : US
Telephone Number : 580-678-7463
Fax Number :
Provider Business Practice Location Address
First Line : 1320 MERCY DR NW
Second Line :
City : CANTON
State : OH
Zip : 44708-2614
Country : US
Telephone Number : 330-489-1000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/02/2022
Last Update Date : 05/07/2026

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