Provider Demographics
NPI:1467770040
Name:LUECKE, ERIN HEISE (MPT)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:HEISE
Last Name:LUECKE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 SUGAR MILL RD
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-3937
Mailing Address - Country:US
Mailing Address - Phone:727-938-8560
Mailing Address - Fax:727-942-4454
Practice Address - Street 1:613 SUGAR MILL RD
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-3937
Practice Address - Country:US
Practice Address - Phone:727-938-8560
Practice Address - Fax:727-942-4454
Is Sole Proprietor?:No
Enumeration Date:2010-05-06
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19183225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist