Provider Demographics
NPI:1417079963
Name:LUKASZCZYK, JUSTYNA (PT)
Entity Type:Individual
Prefix:MRS
First Name:JUSTYNA
Middle Name:
Last Name:LUKASZCZYK
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:PO BOX 5100
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00823-5100
Mailing Address - Country:US
Mailing Address - Phone:340-772-9557
Mailing Address - Fax:340-772-9558
Practice Address - Street 1:SUNNY ISLE PROFESSIONAL BLDG, SUITE 6F
Practice Address - Street 2:
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820
Practice Address - Country:US
Practice Address - Phone:340-772-9557
Practice Address - Fax:340-772-9558
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7461225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO7461OtherPHYSICAL THERAPIST