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General NPI Number Information
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NPI Number | 1811565740
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Entity Type | Individual
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Provider Name | LUKE WILLIAM REARDON
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Gender | Male
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Dates
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Enumeration Date | 06/16/2021
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 1220 W POPLAR ST STE A
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City | WALLA WALLA
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State | WA
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Zip | 99362-2757
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Country | US
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Telephone | 509-540-3286
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Fax | 509-285-0982
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Provider Business Mailing Address
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Address Line | 56 N COLLEGE AVE UNIT 1
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City | COLLEGE PLACE
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State | WA
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Zip | 99324-1048
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Country | US
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Telephone | 509-876-8900
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Fax | 509-593-4006
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT61177063
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License Number State | WA
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