Provider Demographics
NPI:1326106352
Name:LUFT, MILLICENT M (PT)
Entity Type:Individual
Prefix:MS
First Name:MILLICENT
Middle Name:M
Last Name:LUFT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2813 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235
Mailing Address - Country:US
Mailing Address - Phone:718-332-4701
Mailing Address - Fax:718-332-4701
Practice Address - Street 1:2813 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235
Practice Address - Country:US
Practice Address - Phone:718-332-4701
Practice Address - Fax:718-332-4701
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002238225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0052770OtherCTHI
1000041252OtherAFFINITY
000312540101OtherHEALTH PLUS
133063POtherHIP
LM2238OtherATLANTIS
Q52662OtherBC BS
P00036523OtherRAIL ROAD MEDICARE
NY00759857Medicaid
LM2238OtherATLANTIS