1407137052 NPI number — MISS SARAH IRENE LUKEN LAT, ATC

Table of content: MISS SARAH IRENE LUKEN LAT, ATC (NPI 1407137052)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407137052 NPI number — MISS SARAH IRENE LUKEN LAT, ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUKEN
Provider First Name:
SARAH
Provider Middle Name:
IRENE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
LAT, ATC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407137052
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8227 NORTHWEST BLVD
Provider Second Line Business Mailing Address:
SUITE 160
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46278-1387
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7883 N STATE ROAD 39
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIZTON
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46149-9575
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-994-4090
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/08/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2255A2300X , with the licence number:  36001510A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 36001510A . This is a "INDIANA PROFESSIONAL LICENSING AGENCY" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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