Provider Demographics
NPI:1275955528
Name:LUCZKOW, PATRICIA (PTA)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:LUCZKOW
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:LUCZKOW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:734 NEWMAN SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:LINCROFT
Mailing Address - State:NJ
Mailing Address - Zip Code:07738-1523
Mailing Address - Country:US
Mailing Address - Phone:732-589-4326
Mailing Address - Fax:
Practice Address - Street 1:734 NEWMAN SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LINCROFT
Practice Address - State:NJ
Practice Address - Zip Code:07738-1523
Practice Address - Country:US
Practice Address - Phone:732-589-4326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-06
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00091300225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant