Provider Demographics
NPI:1932892924
Name:LUKENS, ALEXANDRIA TESS (PTA)
Entity Type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:TESS
Last Name:LUKENS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2219 SW 74TH ST STE 109-115
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-3931
Mailing Address - Country:US
Mailing Address - Phone:305-355-3239
Mailing Address - Fax:
Practice Address - Street 1:2219 SW 74TH ST STE 109-115
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-3931
Practice Address - Country:US
Practice Address - Phone:305-355-3239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-26
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3718225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant