Provider Demographics
NPI:1922404086
Name:LUCKEY, HAILEE (DPT)
Entity Type:Individual
Prefix:
First Name:HAILEE
Middle Name:
Last Name:LUCKEY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2123 E 23RD AVE SOUTH
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NEBRASKA
Mailing Address - Zip Code:68025
Mailing Address - Country:UM
Mailing Address - Phone:402-721-1112
Mailing Address - Fax:402-721-1113
Practice Address - Street 1:2123 E 23RD AVE S
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-2498
Practice Address - Country:US
Practice Address - Phone:402-721-1112
Practice Address - Fax:402-721-1113
Is Sole Proprietor?:No
Enumeration Date:2014-11-17
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3342225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist