Provider Demographics
NPI:1952419541
Name:LUKES, LYNNE M (PTA)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:M
Last Name:LUKES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:LYNNE
Other - Middle Name:M
Other - Last Name:SEVEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:323 S 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:STURGEON BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54235-1401
Mailing Address - Country:US
Mailing Address - Phone:920-743-5566
Mailing Address - Fax:
Practice Address - Street 1:1510 FREMONT ST
Practice Address - Street 2:
Practice Address - City:ALGOMA
Practice Address - State:WI
Practice Address - Zip Code:54201-1948
Practice Address - Country:US
Practice Address - Phone:920-487-9888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI503-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40324000Medicaid
WI40324000Medicaid