Provider Demographics
NPI:1396911764
Name:HEALING HANDS THERAPY CENTER, LLC
Entity type:Organization
Organization Name:HEALING HANDS THERAPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:LUCKOW
Authorized Official - Suffix:
Authorized Official - Credentials:NMT PT
Authorized Official - Phone:414-476-9008
Mailing Address - Street 1:W156N9666 PILGRIM RD
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-5102
Mailing Address - Country:US
Mailing Address - Phone:414-476-9008
Mailing Address - Fax:414-476-9089
Practice Address - Street 1:W156N9666 PILGRIM ROAD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022-4257
Practice Address - Country:US
Practice Address - Phone:414-476-9008
Practice Address - Fax:414-476-9089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41566900Medicaid
WI41566900Medicaid