Provider Demographics
NPI:1194159400
Name:LUCKER, ELIZABETH (PT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:LUCKER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1536 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-2167
Mailing Address - Country:US
Mailing Address - Phone:212-861-2630
Mailing Address - Fax:212-861-2685
Practice Address - Street 1:223 KATONAH AVE
Practice Address - Street 2:STE. C
Practice Address - City:KATONAH
Practice Address - State:NY
Practice Address - Zip Code:10536-2146
Practice Address - Country:US
Practice Address - Phone:914-232-1480
Practice Address - Fax:914-232-3341
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-23
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036683225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist