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NPI Code Detail

MEDICARE: LYNNE M LUKES PTA

MEDICARE: LYNNE M LUKES PTA
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
1225200000XPhysical Therapy Assistant503-19WI

Other Identifiers

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

General Provider Information

NPI Number : 1952419541
Entity Type Code : Individual
Provider Name (Legal Business Name) : LYNNE M LUKES PTA
Provider Business Mailing Address
First Line : 323 S 18TH AVE
Second Line :
City : STURGEON BAY
State : WI
Zip : 54235-1401
Country : US
Telephone Number : 920-743-5566
Fax Number :
Provider Business Practice Location Address
First Line : 1510 FREMONT ST
Second Line :
City : ALGOMA
State : WI
Zip : 54201-1948
Country : US
Telephone Number : 920-487-9888
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2006
Last Update Date : 10/20/2016

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Directions to “ LYNNE M LUKES PTA” Practice Location

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