Provider Demographics
NPI:1033584545
Name:GROSSKREUTZ, LUKE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:
Last Name:GROSSKREUTZ
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 DERONDA ST
Mailing Address - Street 2:
Mailing Address - City:AMERY
Mailing Address - State:WI
Mailing Address - Zip Code:54001-1404
Mailing Address - Country:US
Mailing Address - Phone:715-268-8171
Mailing Address - Fax:
Practice Address - Street 1:400 DERONDA ST
Practice Address - Street 2:
Practice Address - City:AMERY
Practice Address - State:WI
Practice Address - Zip Code:54001-1404
Practice Address - Country:US
Practice Address - Phone:715-268-8171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12881225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist