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NPI Code Detail

MEDICARE: AUTUMN LUKE

MEDICARE: AUTUMN LUKE
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
1225100000XPhysical Therapist5501018372MI

General Provider Information

NPI Number : 1194242412
Entity Type Code : Individual
Provider Name (Legal Business Name) : AUTUMN LUKE
Provider Business Mailing Address
First Line : 607 DEWEY AVE NW STE 300
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49504-7335
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1175 WILSON AVE NW
Second Line :
City : WALKER
State : MI
Zip : 49534-6407
Country : US
Telephone Number : 616-284-3686
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/28/2017
Last Update Date : 08/28/2017

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Directions to “ AUTUMN LUKE ” Practice Location

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