Individual
AMANDA LUKENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
230 MICHIGAN ST NE STE 104, GRAND RAPIDS, MI 49503-2550
(616) 391-7710
Mailing address
230 MICHIGAN ST NE STE 104, GRAND RAPIDS, MI 49503-2550
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501017309
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5501017309
—
MI
Enumeration date
03/16/2018
Last updated
03/16/2018
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