Provider Demographics
NPI:1427570415
Name:TABOR, LUKE FRANKLIN (PT)
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:FRANKLIN
Last Name:TABOR
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 YEARLING PL
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-7681
Mailing Address - Country:US
Mailing Address - Phone:804-335-5188
Mailing Address - Fax:
Practice Address - Street 1:316 E MCLEOD RD STE VE101
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-6491
Practice Address - Country:US
Practice Address - Phone:804-335-5188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-11
Last Update Date:2017-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305206072225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist