Provider Demographics
NPI:1023292679
Name:LUTZKE, CARRIE BROOKE (DPT)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:BROOKE
Last Name:LUTZKE
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 1:187 E MARKET ST
Mailing Address - Street 2:SUITE 142
Mailing Address - City:RHINEBECK
Mailing Address - State:NY
Mailing Address - Zip Code:12572-1727
Mailing Address - Country:US
Mailing Address - Phone:845-876-3595
Mailing Address - Fax:
Practice Address - Street 1:187 E MARKET ST
Practice Address - Street 2:SUITE 142
Practice Address - City:RHINEBECK
Practice Address - State:NY
Practice Address - Zip Code:12572-1727
Practice Address - Country:US
Practice Address - Phone:845-876-3595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-18
Last Update Date:2008-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029926225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist