Provider Demographics
NPI:1598391492
Name:MATZEN, LUKE (PT, DPT)
Entity type:Individual
Prefix:
First Name:LUKE
Middle Name:
Last Name:MATZEN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 WRIGHT ST
Mailing Address - Street 2:
Mailing Address - City:BLAIR
Mailing Address - State:NE
Mailing Address - Zip Code:68008-1267
Mailing Address - Country:US
Mailing Address - Phone:402-658-5430
Mailing Address - Fax:
Practice Address - Street 1:1633 S INDUSTRIAL WAY STE B
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-6713
Practice Address - Country:US
Practice Address - Phone:907-260-2603
Practice Address - Fax:844-955-1845
Is Sole Proprietor?:No
Enumeration Date:2020-03-23
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4004225100000X
AK1834752251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist