Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 2305213754 | VA |
NPI | 1174138101 |
---|---|
Provider Name | Meghan Luczkowski |
First Address | Richmond, VA 23221-2865 |
Second Address | Richmond, VA 23284-9058 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2020 |
Last Update Date | 15/09/2020 |