Provider Demographics
NPI:1194838672
Name:LUCUSKI, LINDA A (MPT)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:A
Last Name:LUCUSKI
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 AGABITI CT
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08610-3201
Mailing Address - Country:US
Mailing Address - Phone:609-888-2928
Mailing Address - Fax:856-741-0109
Practice Address - Street 1:443 LAUREL OAK RD
Practice Address - Street 2:SUITE 200
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4451
Practice Address - Country:US
Practice Address - Phone:856-741-7400
Practice Address - Fax:856-741-0109
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00453200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist