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NPI Code Detail

MEDICARE: LUKE ALPHONSO

MEDICARE: LUKE ALPHONSO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225700000XMassage TherapistLAMT6960LA

General Provider Information

NPI Number : 1154910024
Entity Type Code : Individual
Provider Name (Legal Business Name) : LUKE ALPHONSO
Provider Business Mailing Address
First Line : 1108 PORT ARTHUR TER
Second Line :
City : LEESVILLE
State : LA
Zip : 71446-4600
Country : US
Telephone Number : 337-377-0477
Fax Number : 337-239-1062
Provider Business Practice Location Address
First Line : 1108 PORT ARTHUR TER
Second Line :
City : LEESVILLE
State : LA
Zip : 71446-4600
Country : US
Telephone Number : 337-377-0477
Fax Number : 337-239-1062
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/14/2021
Last Update Date : 01/14/2021

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Directions to “ LUKE ALPHONSO ” Practice Location

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