Provider Demographics
NPI:1134465594
Name:LUECKE, ANNA (DPT)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:LUECKE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6755 S IVY ST
Mailing Address - Street 2:APT A6
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-6244
Mailing Address - Country:US
Mailing Address - Phone:303-840-7325
Mailing Address - Fax:
Practice Address - Street 1:16522 KEYSTONE BLVD STE N
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-3302
Practice Address - Country:US
Practice Address - Phone:303-840-7325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-12
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0011761225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist