Provider Demographics
NPI:1407967110
Name:HENRY, LUKE B (MSPT)
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:B
Last Name:HENRY
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 1:1133 COLLEGE AVE STE G200
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-2934
Mailing Address - Country:US
Mailing Address - Phone:785-539-9669
Mailing Address - Fax:785-539-9779
Practice Address - Street 1:1133 COLLEGE AVE STE G200
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-2934
Practice Address - Country:US
Practice Address - Phone:785-539-9669
Practice Address - Fax:785-539-9779
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-03031225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
141095Medicare ID - Type Unspecified