Provider Demographics
NPI:1407909260
Name:MARTIN, LUCAS P (PT)
Entity Type:Individual
Prefix:
First Name:LUCAS
Middle Name:P
Last Name:MARTIN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:73 NEWTON RD UNIT 101
Mailing Address - Street 2:
Mailing Address - City:PLAISTOW
Mailing Address - State:NH
Mailing Address - Zip Code:03865-2440
Mailing Address - Country:US
Mailing Address - Phone:978-338-8727
Mailing Address - Fax:978-388-7373
Practice Address - Street 1:7 WORKS WAY UNIT 205
Practice Address - Street 2:
Practice Address - City:SOMERSWORTH
Practice Address - State:NH
Practice Address - Zip Code:03878-1640
Practice Address - Country:US
Practice Address - Phone:603-841-5441
Practice Address - Fax:603-841-1640
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH3408225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0039585OtherLABOR AND INDUSTRIES#
WA1134MAOtherBLUE SHIELD #