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General NPI Number Information
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NPI Number | 1992594147
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Entity Type | Individual
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Provider Name | LUKE HENDERSON PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 05/05/2025
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Last Update Date | 05/05/2025
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Provider Practice Location Address
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Address Line | 2550 SANDY PLAINS RD STE 140
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City | MARIETTA
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State | GA
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Zip | 30066-7210
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Country | US
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Telephone | 770-438-5162
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Fax |
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Provider Business Mailing Address
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Address Line | 7869 199TH RD
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City | LIVE OAK
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State | FL
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Zip | 32060-7748
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Country | US
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Telephone | 386-249-9049
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Fax |
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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 |
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License Number State |
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