Provider Demographics
NPI:1174491971
Name:PTA ON THE ROAD PLLC
Entity type:Organization
Organization Name:PTA ON THE ROAD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LUCAS
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:929-486-1330
Mailing Address - Street 1:701 BUSHWICK AVE APT 1B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221-2553
Mailing Address - Country:US
Mailing Address - Phone:929-486-1330
Mailing Address - Fax:
Practice Address - Street 1:701 BUSHWICK AVE APT 1B
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11221-2553
Practice Address - Country:US
Practice Address - Phone:929-486-1330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-24
Last Update Date:2025-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy