Provider Demographics
NPI:1376678128
Name:LUKOWIAK, PAUL (PT)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:
Last Name:LUKOWIAK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4027 S 1330 E
Mailing Address - Street 2:
Mailing Address - City:GREENTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:46936-9774
Mailing Address - Country:US
Mailing Address - Phone:765-628-7018
Mailing Address - Fax:
Practice Address - Street 1:2146 E MARKLAND AVE
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-6240
Practice Address - Country:US
Practice Address - Phone:765-454-9748
Practice Address - Fax:765-454-9759
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05006820A225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000375492OtherANTHEM