Healthcare Provider Details

I. General information

NPI: 1659101707
Provider Name (Legal Business Name): LUKE FAHEY DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2024
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 WHARTON CIR STE 140
TRIADELPHIA WV
26059-1387
US

IV. Provider business mailing address

1500 GRAND CENTRAL AVE STE 101
VIENNA WV
26105-1079
US

V. Phone/Fax

Practice location:
  • Phone: 304-693-2377
  • Fax:
Mailing address:
  • Phone: 304-693-2781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: