Healthcare Provider Details

I. General information

NPI: 1356130264
Provider Name (Legal Business Name): LUKE LUSHIN DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2025
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E 186TH ST # A
WESTFIELD IN
46074-2001
US

IV. Provider business mailing address

6450 W 500 S
RUSSIAVILLE IN
46979-9511
US

V. Phone/Fax

Practice location:
  • Phone: 317-804-3501
  • Fax:
Mailing address:
  • Phone: 765-753-0632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05016125A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: