Provider Demographics
NPI:1417405440
Name:LUCAS, SCOTT (AT)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:
Last Name:LUCAS
Suffix:
Gender:M
Credentials:AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:OH
Mailing Address - Zip Code:44146-2118
Mailing Address - Country:US
Mailing Address - Phone:440-708-3208
Mailing Address - Fax:
Practice Address - Street 1:3042 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:AUSTINBURG
Practice Address - State:OH
Practice Address - Zip Code:44010-9745
Practice Address - Country:US
Practice Address - Phone:440-708-3208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-19
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT0051292255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer