Healthcare Provider Details

I. General information

NPI: 1639147796
Provider Name (Legal Business Name): OLIVER LEYSON LU PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6215 E FLORIDA ST
EVANSVILLE IN
47715-2877
US

IV. Provider business mailing address

6215 E FLORIDA ST
EVANSVILLE IN
47715-2877
US

V. Phone/Fax

Practice location:
  • Phone: 812-401-5210
  • Fax: 812-401-5220
Mailing address:
  • Phone: 812-401-5210
  • Fax: 812-401-5220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05006155
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: