Provider Demographics
NPI:1134508815
Name:MCCULLAGH, LUKE
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:
Last Name:MCCULLAGH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3776 E ARMSTRONG RD
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46538-8867
Mailing Address - Country:US
Mailing Address - Phone:440-364-9869
Mailing Address - Fax:
Practice Address - Street 1:2655 W NATIONAL RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-3617
Practice Address - Country:US
Practice Address - Phone:937-325-1531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-27
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH015208225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist