Healthcare Provider Details

I. General information

NPI: 1285296947
Provider Name (Legal Business Name): LUKE JOSEPH MCCARTHY ATC, LAT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2019
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15301 WARREN SHINGLE RD
BEALE AFB CA
95903-1905
US

IV. Provider business mailing address

15301 WARREN SHINGLE RD
BEALE AFB CA
95903-1905
US

V. Phone/Fax

Practice location:
  • Phone: 530-634-9399
  • Fax:
Mailing address:
  • Phone: 530-634-9399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT004477
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: