Provider Demographics
NPI:1922473172
Name:BURTNETT, LUKE (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:
Last Name:BURTNETT
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5507 TRIN ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-1846
Mailing Address - Country:US
Mailing Address - Phone:717-805-9407
Mailing Address - Fax:
Practice Address - Street 1:GEORGETOWN UNIVERSITY ATHLETIC DEPARTMENT
Practice Address - Street 2:MCDONOUGH ARENA
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20057-0001
Practice Address - Country:US
Practice Address - Phone:202-687-2362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-13
Last Update Date:2015-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0057092255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer