Provider Demographics
NPI:1447311220
Name:LUKE KLAJA PT PC
Entity type:Organization
Organization Name:LUKE KLAJA PT PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBBE
Authorized Official - Middle Name:K
Authorized Official - Last Name:KLAJA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-882-4544
Mailing Address - Street 1:204 NORTH 10TH STREET
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-2817
Mailing Address - Country:US
Mailing Address - Phone:541-882-4544
Mailing Address - Fax:541-882-7258
Practice Address - Street 1:204 NORTH 10TH STREET
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-2817
Practice Address - Country:US
Practice Address - Phone:541-882-4544
Practice Address - Fax:541-882-7258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR014089Medicaid
OR014089Medicaid