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Organization
LB PHYSICAL THERAPY INC.
Active
Organization
LB PHYSICAL THERAPY INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PIERRE A LUYCKX DPT (OWNER)
(269) 556-0881
Entity
Organization
Contact information
Practice address
2800 NILES RD, SAINT JOSEPH, MI 49085-3317
(269) 408-1944
(269) 408-1946
Mailing address
2746 SANCTUARY DR, STEVENSVILLE, MI 49127-8313
(269) 408-1990
(269) 408-1993
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
5501007604
MI
225100000X
Physical Therapist
Primary
5501008773
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
650A157160
BLUE CROSS BLUE SHIELD
MI
Enumeration date
08/18/2006
Last updated
02/04/2011
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