Provider Demographics
NPI:1811579063
Name:LUKKEN, ERIC
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:LUKKEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10838 FOSSIL DUST DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80908-7005
Mailing Address - Country:US
Mailing Address - Phone:719-359-0139
Mailing Address - Fax:
Practice Address - Street 1:5320 MARK DABLING BLVD STE 100
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-3839
Practice Address - Country:US
Practice Address - Phone:719-592-1584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist