Provider Demographics
NPI:1114328788
Name:LUCMAN, AL-RAJIV
Entity Type:Individual
Prefix:
First Name:AL-RAJIV
Middle Name:
Last Name:LUCMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4011 N PINE ISLAND RD APT 404
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-6520
Mailing Address - Country:US
Mailing Address - Phone:954-716-3213
Mailing Address - Fax:
Practice Address - Street 1:1580 SAWGRASS CORPORATE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-2860
Practice Address - Country:US
Practice Address - Phone:954-332-4445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-14
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1241541225100000X
DEJ1-0003078225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist