Provider Demographics
NPI:1942758743
Name:LUKASIEWICZ, WILLIAM (MED ATC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:LUKASIEWICZ
Suffix:
Gender:M
Credentials:MED ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5600 CITY AVE
Mailing Address - Street 2:SAINT JOSEPH'S UNIVERSITY SPORTS MEDICINE
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-1308
Mailing Address - Country:US
Mailing Address - Phone:610-660-3234
Mailing Address - Fax:610-660-2577
Practice Address - Street 1:5600 CITY AVE
Practice Address - Street 2:SAINT JOSEPH'S UNIVERSITY SPORTS MEDICINE
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-1308
Practice Address - Country:US
Practice Address - Phone:610-660-3234
Practice Address - Fax:610-660-2577
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-21
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART001161A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer