Provider Demographics
NPI:1093528473
Name:TYKSINSKI, LUCIA (LMT)
Entity type:Individual
Prefix:
First Name:LUCIA
Middle Name:
Last Name:TYKSINSKI
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2706 ACCOMAC ST APT B
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63104-2220
Mailing Address - Country:US
Mailing Address - Phone:314-550-8657
Mailing Address - Fax:
Practice Address - Street 1:10000 WATSON RD BLDG STE2L-12
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63126-1848
Practice Address - Country:US
Practice Address - Phone:314-550-8657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013028850225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist