Provider Demographics
NPI:1235539487
Name:LUCK, EMILY
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:LUCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:747 E COUNTY LINE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-1081
Mailing Address - Country:US
Mailing Address - Phone:317-881-6617
Mailing Address - Fax:317-881-6643
Practice Address - Street 1:747 E COUNTY LINE RD
Practice Address - Street 2:SUITE A
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-1081
Practice Address - Country:US
Practice Address - Phone:317-881-6617
Practice Address - Fax:317-881-6643
Is Sole Proprietor?:No
Enumeration Date:2014-08-25
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05011494A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist