Provider Demographics
NPI:1336281682
Name:LUCAS, ROLAND NEIL (PT)
Entity Type:Individual
Prefix:
First Name:ROLAND
Middle Name:NEIL
Last Name:LUCAS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:347 SARA AVE
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94086-5940
Mailing Address - Country:US
Mailing Address - Phone:408-977-4142
Mailing Address - Fax:408-774-0851
Practice Address - Street 1:1055 SUNNYVALE SARATOGA RD
Practice Address - Street 2:SUITE 6
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-2503
Practice Address - Country:US
Practice Address - Phone:408-774-1424
Practice Address - Fax:408-774-0851
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20809225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT208090Medicare ID - Type UnspecifiedPHYSICAL THERAPY