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NPI Code Detail

MEDICARE: MR. LUKE DAVID POORE PTA

MEDICARE:  MR. LUKE DAVID POORE  PTA
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
1225200000XPhysical Therapy Assistant994NE

General Provider Information

NPI Number : 1831593185
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. LUKE DAVID POORE PTA
Provider Business Mailing Address
First Line : 322 N SEWARD ST
Second Line :
City : RED CLOUD
State : NE
Zip : 68970-2366
Country : US
Telephone Number : 308-390-1382
Fax Number :
Provider Business Practice Location Address
First Line : 621 N FRANKLIN ST
Second Line :
City : RED CLOUD
State : NE
Zip : 68970-2260
Country : US
Telephone Number : 402-746-5611
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/15/2014
Last Update Date : 10/15/2014

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Directions to “ MR. LUKE DAVID POORE PTA” Practice Location

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