Provider Demographics
NPI:1346228731
Name:KOHLEY, LUKE W (MSPT)
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:W
Last Name:KOHLEY
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-602-2028
Practice Address - Street 1:38505 BROOTEN RD STE C
Practice Address - Street 2:
Practice Address - City:PACIFIC CITY
Practice Address - State:OR
Practice Address - Zip Code:97135
Practice Address - Country:US
Practice Address - Phone:503-965-6400
Practice Address - Fax:503-965-9555
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4204225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR182881Medicaid
OR182881Medicaid