Provider Demographics
NPI:1952658601
Name:MYERS, LUKE (PT)
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:
Last Name:MYERS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8300 CONSTITUTION AVENUE NE
Mailing Address - Street 2:KASEMAN HOSPITAL INTENSIVE OUTPATIENT PROGRAM
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110
Mailing Address - Country:US
Mailing Address - Phone:505-291-2967
Mailing Address - Fax:
Practice Address - Street 1:8300 CONSTITUTION AVENUE NE
Practice Address - Street 2:KASEMAN HOSPITAL INTENSIVE OUTPATIENT PROGRAM
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110
Practice Address - Country:US
Practice Address - Phone:505-291-2967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1212225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist