Provider Demographics
NPI:1881815348
Name:WORRELL, LUKE (PTA)
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:
Last Name:WORRELL
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:LESTER
Other - Middle Name:L
Other - Last Name:WORRELL
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:705 E ALAMEDA ST
Mailing Address - Street 2:APARTMENT#1
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-6426
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9929 RACE TRACK RD
Practice Address - Street 2:SUNBELT STAFFING
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-4458
Practice Address - Country:US
Practice Address - Phone:800-659-1522
Practice Address - Fax:866-360-5916
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA-0499225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant