Provider Demographics
NPI:1619061744
Name:LUCHT, NEIL WALTER (RPT)
Entity Type:Individual
Prefix:MR
First Name:NEIL
Middle Name:WALTER
Last Name:LUCHT
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 E 9TH ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-5708
Mailing Address - Country:US
Mailing Address - Phone:405-340-0770
Mailing Address - Fax:405-330-5302
Practice Address - Street 1:1225 E 9TH ST
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-5708
Practice Address - Country:US
Practice Address - Phone:405-340-0770
Practice Address - Fax:405-330-5302
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT 504225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK388445827Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE NUMBE