Most Relevant Information
Provider Data
| NPI Number: | 1003228057 |
| Provider Name: | LUCAS RYAN PETKEWITZ DPT |
| Entity Type: | Individual |
| Taxonomy Code: | 225100000X |
| Specialty: | Physical Therapist |
| License Number: | PT014800 |
Most Important Dates
| Enumeration Date: | 05/27/2014 |
| Last Updated: | 04/17/2018 |
Provider Practice Location
307 BOATNER RD STE 114
EGLIN AFB
FL
325421302
Practice Location Phone/Fax
| Phone: | 8508838600 |
| Fax: |
Provider Mailing Location
307 BOATNER RD STE 114
EGLIN AFB
FL
325421302
Provider Mailing Phone/Fax
| Phone: | 8508838600 |
| Fax: |