Provider Demographics
NPI:1619492980
Name:FORD, LUKE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:
Last Name:FORD
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 LEIGHTON AVE
Mailing Address - Street 2:P.O. BOX 2208
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36202
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:731 LEIGHTON AVE.
Practice Address - Street 2:P.O. BOX 2208
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36202-2208
Practice Address - Country:US
Practice Address - Phone:256-235-5688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-08
Last Update Date:2017-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH8534225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty