Provider Demographics
NPI:1700497948
Name:LAMARRE, LUKE JARED (PT, DPT, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:JARED
Last Name:LAMARRE
Suffix:
Gender:M
Credentials:PT, DPT, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 APPALOOSA BLVD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32934-7870
Mailing Address - Country:US
Mailing Address - Phone:321-609-0670
Mailing Address - Fax:
Practice Address - Street 1:6300 N WICKHAM RD STE 133B
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-2029
Practice Address - Country:US
Practice Address - Phone:321-421-7117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT36034208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation