Provider Demographics
NPI:1659563278
Name:ANGEL, LUKE JOSEPH (DPT)
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:JOSEPH
Last Name:ANGEL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:457 ANIMAS VIEW DR
Mailing Address - Street 2:#19
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-9001
Mailing Address - Country:US
Mailing Address - Phone:970-759-1141
Mailing Address - Fax:
Practice Address - Street 1:1485 FLORIDA RD
Practice Address - Street 2:C206
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-6881
Practice Address - Country:US
Practice Address - Phone:970-247-9415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-16
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO79512251X0800X
WA102732251X0800X
OR53302251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO11365034Medicare UPIN