Basic Information
| Provider Information | |||||||||
| NPI: | 1205865821 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MASSEY | ||||||||
| FirstName: | LUKE | ||||||||
| MiddleName: | BRANNON | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PA-C, ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 517 LACEY LN | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352261622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3343328692 | ||||||||
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| Practice Location | |||||||||
| Address1: | 121 N 20TH ST | ||||||||
| Address2: | #18 | ||||||||
| City: | OPELIKA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 368015449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3347498303 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2006 | ||||||||
| LastUpdateDate: | 01/10/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer | 363A00000X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.