Provider Demographics
NPI:1093285942
Name:PATIN, LUCAS (ATC)
Entity Type:Individual
Prefix:
First Name:LUCAS
Middle Name:
Last Name:PATIN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 N CAROLINA ST
Mailing Address - Street 2:
Mailing Address - City:NEW ROADS
Mailing Address - State:LA
Mailing Address - Zip Code:70760-3607
Mailing Address - Country:US
Mailing Address - Phone:225-240-2850
Mailing Address - Fax:
Practice Address - Street 1:449 BEN HUR RD.
Practice Address - Street 2:APT. 4311
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70820
Practice Address - Country:US
Practice Address - Phone:225-240-2850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-03
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAXHB724824416Medicaid