Provider Demographics
NPI:1932109758
Name:LUKENS, STEVEN CHARLES (MPT)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:CHARLES
Last Name:LUKENS
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-1526
Mailing Address - Country:US
Mailing Address - Phone:248-922-9001
Mailing Address - Fax:248-922-9020
Practice Address - Street 1:32 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-1526
Practice Address - Country:US
Practice Address - Phone:248-922-9001
Practice Address - Fax:248-922-9020
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010511225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN96240002Medicare ID - Type UnspecifiedMEMBER NUMBER MC PART B