Provider Demographics
NPI:1417356890
Name:GASPAR, LUCAS J (DPT)
Entity Type:Individual
Prefix:
First Name:LUCAS
Middle Name:J
Last Name:GASPAR
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 MAMARONECK AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-5224
Mailing Address - Country:US
Mailing Address - Phone:267-831-4293
Mailing Address - Fax:
Practice Address - Street 1:10787 RANDOLPH ST STE 220
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46307-7615
Practice Address - Country:US
Practice Address - Phone:219-333-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-21
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05012065A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist