Provider Demographics
NPI:1811455108
Name:LUCKEY, HEATHER
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:LUCKEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 GREENWICH OFFICE PARK
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06831-5151
Mailing Address - Country:US
Mailing Address - Phone:203-869-1145
Mailing Address - Fax:203-618-1721
Practice Address - Street 1:6 GREENWICH OFFICE PARK
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06831-5151
Practice Address - Country:US
Practice Address - Phone:203-869-1145
Practice Address - Fax:203-618-1721
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-06
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT121462251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics