Provider Demographics
NPI:1174536528
Name:LAUCKNER-GICK, CARA (LPT)
Entity type:Individual
Prefix:
First Name:CARA
Middle Name:
Last Name:LAUCKNER-GICK
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 MERCER ST
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-3229
Mailing Address - Country:US
Mailing Address - Phone:856-665-2827
Mailing Address - Fax:856-596-8553
Practice Address - Street 1:2601 EVESHAM RD
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003
Practice Address - Country:US
Practice Address - Phone:856-482-4451
Practice Address - Fax:856-596-8553
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQAO10514225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA316643Medicare ID - Type UnspecifiedMEDICARE #