Provider Demographics
NPI:1457816944
Name:LUTKOWSKI, JENNIFER RUTH (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RUTH
Last Name:LUTKOWSKI
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 RAFFERTY ST
Mailing Address - Street 2:
Mailing Address - City:OLD FORGE
Mailing Address - State:PA
Mailing Address - Zip Code:18518-2105
Mailing Address - Country:US
Mailing Address - Phone:570-562-1167
Mailing Address - Fax:
Practice Address - Street 1:702 3RD AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5845
Practice Address - Country:US
Practice Address - Phone:570-283-5848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-08
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT011715L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist