MEDICARE: MRS. CORLETTE ALEXIS LUKE-CAMBRIDGE PT

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
1	225100000X	Physical Therapist	PT008318	GA

General Provider Information

NPI Number	:	1841457900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CORLETTE ALEXIS LUKE-CAMBRIDGE PT

Provider Business Mailing Address
First Line	:	290 HIGHWAY 314 STE B
Second Line	:
City	:	FAYETTEVILLE
State	:	GA
Zip	:	30214-7813
Country	:	US
Telephone Number	:	678-789-6400
Fax Number	:	678-789-6400

Provider Business Practice Location Address
First Line	:	290 HIGHWAY 314 STE B
Second Line	:
City	:	FAYETTEVILLE
State	:	GA
Zip	:	30214-7813
Country	:	US
Telephone Number	:	404-994-7727
Fax Number	:	404-994-7728

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2008
Last Update Date	:	07/26/2021

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