Provider Demographics
NPI:1205865821
Name:MASSEY, LUKE BRANNON (PA-C, ATC)
Entity Type:Individual
Prefix:MR
First Name:LUKE
Middle Name:BRANNON
Last Name:MASSEY
Suffix:
Gender:M
Credentials:PA-C, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 LACEY LN
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35226-1622
Mailing Address - Country:US
Mailing Address - Phone:334-332-8692
Mailing Address - Fax:
Practice Address - Street 1:121 N 20TH ST
Practice Address - Street 2:#18
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-5449
Practice Address - Country:US
Practice Address - Phone:334-749-8303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer