Provider Demographics
NPI:1598312266
Name:KLUKA, SANDRA BUSH (PT)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:BUSH
Last Name:KLUKA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:BUSH
Other - Last Name:KLUKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:474 AUTUMN SPRINGS CT
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-7472
Mailing Address - Country:US
Mailing Address - Phone:317-361-2292
Mailing Address - Fax:
Practice Address - Street 1:8601 SHELBY ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-6596
Practice Address - Country:US
Practice Address - Phone:317-885-4446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-19
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05006893A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist