Provider Demographics
NPI:1619916285
Name:LUKASIEWICZ, AMY C (PT)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:C
Last Name:LUKASIEWICZ
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 1:1641 SURREY LN
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-2525
Mailing Address - Country:US
Mailing Address - Phone:610-449-5678
Mailing Address - Fax:
Practice Address - Street 1:57 W EAGLE RD
Practice Address - Street 2:
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-2234
Practice Address - Country:US
Practice Address - Phone:610-789-9887
Practice Address - Fax:610-789-9883
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT-006920L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAAL024364Medicare ID - Type UnspecifiedMEDICARE #