Basic Information
Provider Information
NPI: 1003001777
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LUK
FirstName: CARMEN
MiddleName: L
NamePrefix:  
NameSuffix:  
Credential: DPT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2108 CHATHAM WAY
Address2:  
City: HARRISBURG
State: PA
PostalCode: 171103960
CountryCode: US
TelephoneNumber: 2678255515
FaxNumber:  
Practice Location
Address1: 4800 LINGLESTOWN RD
Address2:  
City: HARRISBURG
State: PA
PostalCode: 171129183
CountryCode: US
TelephoneNumber: 7176528511
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/06/2007
LastUpdateDate: 09/06/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000XPT013938PAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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