Provider Demographics
NPI:1114481850
Name:LUETKENHAUS, MCKENNA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MCKENNA
Middle Name:
Last Name:LUETKENHAUS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:MCKENNA
Other - Middle Name:
Other - Last Name:SETLIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:PO BOX 34669
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-0669
Mailing Address - Country:US
Mailing Address - Phone:402-934-0045
Mailing Address - Fax:
Practice Address - Street 1:4235 N 90TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-4136
Practice Address - Country:US
Practice Address - Phone:402-934-0045
Practice Address - Fax:402-934-6562
Is Sole Proprietor?:No
Enumeration Date:2019-01-28
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0014859225100000X
OK5409225100000X
NE3910225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist