Individual
MARY A LUCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1705 S HYCREST DR, APPLETON, WI 54914-5155
(920) 832-1213
Mailing address
1705 S HYCREST DR, APPLETON, WI 54914-5155
(920) 832-1213
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2321-19
WI
Other
Enumeration date
06/15/2015
Last updated
10/07/2021
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