Provider Demographics
NPI:1831407741
Name:PLUNK, LAKEN MARIE (PTA)
Entity type:Individual
Prefix:MRS
First Name:LAKEN
Middle Name:MARIE
Last Name:PLUNK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 W COLLIN RAYE DR
Mailing Address - Street 2:
Mailing Address - City:DE QUEEN
Mailing Address - State:AR
Mailing Address - Zip Code:71832-2502
Mailing Address - Country:US
Mailing Address - Phone:870-648-4990
Mailing Address - Fax:870-642-7250
Practice Address - Street 1:1306 W COLLIN RAYE DR
Practice Address - Street 2:
Practice Address - City:DE QUEEN
Practice Address - State:AR
Practice Address - Zip Code:71832-2502
Practice Address - Country:US
Practice Address - Phone:870-648-4990
Practice Address - Fax:870-642-7250
Is Sole Proprietor?:No
Enumeration Date:2010-09-14
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA 2458225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant