Provider Demographics
NPI:1962574038
Name:LUY, ALEXANDER T (PT)
Entity type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:T
Last Name:LUY
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 1:2782 N HIGHLAND AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-1798
Mailing Address - Country:US
Mailing Address - Phone:731-664-1172
Mailing Address - Fax:731-664-3139
Practice Address - Street 1:2782 N HIGHLAND AVE
Practice Address - Street 2:SUITE A
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-1798
Practice Address - Country:US
Practice Address - Phone:731-664-1172
Practice Address - Fax:731-664-3139
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1966225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3654228Medicaid
TN3654228Medicare ID - Type Unspecified