Provider Demographics
NPI:1194166439
Name:LUKE, JASON (DPT)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:
Last Name:LUKE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 288
Mailing Address - Street 2:
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766
Mailing Address - Country:US
Mailing Address - Phone:808-632-0033
Mailing Address - Fax:808-632-0077
Practice Address - Street 1:3088 AUKELE ST
Practice Address - Street 2:
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-2124
Practice Address - Country:US
Practice Address - Phone:808-632-0033
Practice Address - Fax:808-632-0077
Is Sole Proprietor?:No
Enumeration Date:2013-07-15
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT3653225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist