Provider Demographics
NPI:1215166525
Name:LUCKE, CHRISTINE MARIE (PT)
Entity type:Individual
Prefix:MISS
First Name:CHRISTINE
Middle Name:MARIE
Last Name:LUCKE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:CHRISTINE
Other - Middle Name:M
Other - Last Name:REICHLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:4273 KEATON CROSSING BLVD
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-8220
Mailing Address - Country:US
Mailing Address - Phone:636-206-6540
Mailing Address - Fax:
Practice Address - Street 1:4273 KEATON CROSSING BLVD
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-8220
Practice Address - Country:US
Practice Address - Phone:636-206-6540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-08
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009005834225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist