Provider Demographics
NPI:1124289913
Name:BIG LUKE LLC
Entity type:Organization
Organization Name:BIG LUKE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:A
Authorized Official - Last Name:FISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:908-903-0100
Mailing Address - Street 1:413 KING GEORGE RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-2816
Mailing Address - Country:US
Mailing Address - Phone:908-903-0100
Mailing Address - Fax:
Practice Address - Street 1:413 KING GEORGE RD
Practice Address - Street 2:SUITE 204
Practice Address - City:BASKING RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07920-2816
Practice Address - Country:US
Practice Address - Phone:908-903-0100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty