Provider Demographics
NPI:1356424675
Name:LUYCKX, PIERRE (DPT)
Entity type:Individual
Prefix:DR
First Name:PIERRE
Middle Name:
Last Name:LUYCKX
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2746 SANCTUARY DR
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49127-8313
Mailing Address - Country:US
Mailing Address - Phone:269-556-0881
Mailing Address - Fax:269-556-0882
Practice Address - Street 1:2800 NILES RD
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-3317
Practice Address - Country:US
Practice Address - Phone:269-408-1994
Practice Address - Fax:269-408-1946
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501007604225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN69330001Medicare PIN