Provider Demographics
NPI:1881045656
Name:LUEKEN, RYAN (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:LUEKEN
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 MAIN ST
Mailing Address - Street 2:MS 552
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77005-1827
Mailing Address - Country:US
Mailing Address - Phone:765-714-5916
Mailing Address - Fax:
Practice Address - Street 1:6100 MAIN ST
Practice Address - Street 2:MS 552
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77005-1827
Practice Address - Country:US
Practice Address - Phone:765-714-5916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT61122255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer