Healthcare Provider Details

I. General information

NPI: 1619422300
Provider Name (Legal Business Name): LUKE NORMAN PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2016
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2619 S WOODLANDS VILLAGE BLVD STE 2
FLAGSTAFF AZ
86001-7227
US

IV. Provider business mailing address

2619 S WOODLANDS VILLAGE BLVD STE 750
FLAGSTAFF AZ
86001-1628
US

V. Phone/Fax

Practice location:
  • Phone: 928-235-5197
  • Fax: 928-224-0802
Mailing address:
  • Phone: 928-235-5197
  • Fax: 928-224-0802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberLPT-034431
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: