Basic Information
| Provider Information | |||||||||
| NPI: | 1023292679 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LUTZKE | ||||||||
| FirstName: | CARRIE | ||||||||
| MiddleName: | BROOKE | ||||||||
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| Credential: | D.P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 187 E MARKET ST | ||||||||
| Address2: | SUITE 142 | ||||||||
| City: | RHINEBECK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125721727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8458763595 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 187 E MARKET ST | ||||||||
| Address2: | SUITE 142 | ||||||||
| City: | RHINEBECK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125721727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8458763595 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/18/2007 | ||||||||
| LastUpdateDate: | 02/03/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 029926 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.