Provider Demographics
NPI:1629224423
Name:ADVANCED ORTHOPEDICS PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:ADVANCED ORTHOPEDICS PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:LUKAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-385-7400
Mailing Address - Street 1:1231 PINE GROVE AVE
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-3500
Mailing Address - Country:US
Mailing Address - Phone:810-985-6300
Mailing Address - Fax:810-985-9320
Practice Address - Street 1:1231 PINE GROVE AVE
Practice Address - Street 2:SUITE 1A
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3500
Practice Address - Country:US
Practice Address - Phone:810-985-6300
Practice Address - Fax:810-985-9320
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED ORTHOPEDIC PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-12
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty