Provider Demographics
NPI:1487403713
Name:LUEKEN, ANNE HAVENGA (DPT)
Entity type:Individual
Prefix:DR
First Name:ANNE
Middle Name:HAVENGA
Last Name:LUEKEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 REC PLEX DR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-4327
Mailing Address - Country:US
Mailing Address - Phone:618-624-3668
Mailing Address - Fax:
Practice Address - Street 1:209 REC PLEX DR
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-4327
Practice Address - Country:US
Practice Address - Phone:618-624-3886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-17
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021029472225100000X
IL070.025892225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist