Healthcare Provider Details

I. General information

NPI: 1043927361
Provider Name (Legal Business Name): DEAN ROXANNE T LUCHE PHYSICAL THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2022
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 TOWN PARK BLVD
EVANS GA
30809-3487
US

IV. Provider business mailing address

415 TOWN PARK BLVD
EVANS GA
30809-3487
US

V. Phone/Fax

Practice location:
  • Phone: 706-868-1707
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT018286
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number048148
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: