Provider Demographics
NPI:1770644643
Name:LUKASZEWICZ, KATHLEEN (PT, PHD)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:
Last Name:LUKASZEWICZ
Suffix:
Gender:F
Credentials:PT, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2849 N PIERCE ST
Mailing Address - Street 2:UNIT C
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-2548
Mailing Address - Country:US
Mailing Address - Phone:414-288-3382
Mailing Address - Fax:
Practice Address - Street 1:604 N 16TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233-2117
Practice Address - Country:US
Practice Address - Phone:414-453-8616
Practice Address - Fax:414-453-6150
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10484-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40463100Medicaid
WI40463100Medicaid