Provider Demographics
NPI:1376071027
Name:LUKKES, KATEY AMANDA (DPT)
Entity Type:Individual
Prefix:
First Name:KATEY
Middle Name:AMANDA
Last Name:LUKKES
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 1:4861 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:SELBY
Mailing Address - State:SD
Mailing Address - Zip Code:57472-2036
Mailing Address - Country:US
Mailing Address - Phone:605-649-7663
Mailing Address - Fax:
Practice Address - Street 1:4861 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:SELBY
Practice Address - State:SD
Practice Address - Zip Code:57472-2036
Practice Address - Country:US
Practice Address - Phone:605-649-7663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-25
Last Update Date:2017-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1681225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist