Provider Demographics
NPI:1669102448
Name:LUKERS, JEREMIAH (LAT, CSCS)
Entity type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:
Last Name:LUKERS
Suffix:
Gender:M
Credentials:LAT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 ROCKY SHOALS TRL
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:GA
Mailing Address - Zip Code:30563-3669
Mailing Address - Country:US
Mailing Address - Phone:814-227-8601
Mailing Address - Fax:
Practice Address - Street 1:176 ROCKY SHOALS TRL
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:GA
Practice Address - Zip Code:30563-3669
Practice Address - Country:US
Practice Address - Phone:814-227-8601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0028882255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer