Provider Demographics
NPI:1992594147
Name:HENDERSON, LUKE (PT, DPT)
Entity type:Individual
Prefix:
First Name:LUKE
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7869 199TH RD
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:FL
Mailing Address - Zip Code:32060-7748
Mailing Address - Country:US
Mailing Address - Phone:386-249-9049
Mailing Address - Fax:
Practice Address - Street 1:2550 SANDY PLAINS RD STE 140
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-7210
Practice Address - Country:US
Practice Address - Phone:770-438-5162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist