Healthcare Provider Details

I. General information

NPI: 1205865821
Provider Name (Legal Business Name): LUKE BRANNON MASSEY PA-C, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 01/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 N 20TH ST #18
OPELIKA AL
36801-5449
US

IV. Provider business mailing address

517 LACEY LN
BIRMINGHAM AL
35226-1622
US

V. Phone/Fax

Practice location:
  • Phone: 334-749-8303
  • Fax:
Mailing address:
  • Phone: 334-332-8692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: