Provider Demographics
NPI:1760680961
Name:HOLIDAY, LUKE NANESTE
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:NANESTE
Last Name:HOLIDAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 E BROADWAY RD APT 2106
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-1752
Mailing Address - Country:US
Mailing Address - Phone:480-215-1488
Mailing Address - Fax:
Practice Address - Street 1:2030 E BROADWAY RD APT 2106
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-1752
Practice Address - Country:US
Practice Address - Phone:480-215-1488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4021225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist