Provider Demographics
NPI:1154998185
Name:LUKE, CHAD A (LMT, CMLT)
Entity type:Individual
Prefix:MR
First Name:CHAD
Middle Name:A
Last Name:LUKE
Suffix:
Gender:M
Credentials:LMT, CMLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43232 WHITETAIL PATH
Mailing Address - Street 2:
Mailing Address - City:BABCOCK RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:33982-5060
Mailing Address - Country:US
Mailing Address - Phone:843-338-2698
Mailing Address - Fax:
Practice Address - Street 1:43232 WHITETAIL PATH
Practice Address - Street 2:
Practice Address - City:BABCOCK RANCH
Practice Address - State:FL
Practice Address - Zip Code:33982-5060
Practice Address - Country:US
Practice Address - Phone:843-338-2698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA77437225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist