MEDICARE: MS. KATHLEEN LUKASZEWICZ P.T., PH.D.

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
1	225100000X	Physical Therapist	10484-024	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770644643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHLEEN LUKASZEWICZ P.T., PH.D.

Provider Business Mailing Address
First Line	:	2849 N PIERCE ST
Second Line	:	UNIT C
City	:	MILWAUKEE
State	:	WI
Zip	:	53212-2548
Country	:	US
Telephone Number	:	414-288-3382
Fax Number	:

Provider Business Practice Location Address
First Line	:	604 N 16TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53233-2117
Country	:	US
Telephone Number	:	414-453-8616
Fax Number	:	414-453-6150

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	12/13/2012

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