Provider Demographics
NPI:1619345147
Name:LUCIUS, NICHOLAS (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:
Last Name:LUCIUS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4731 S SANTA FE CIR # 3-4
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80110-2200
Mailing Address - Country:US
Mailing Address - Phone:720-617-6151
Mailing Address - Fax:720-617-6152
Practice Address - Street 1:4731 S SANTA FE CIR
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80110-2200
Practice Address - Country:US
Practice Address - Phone:248-921-2282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-15
Last Update Date:2021-06-30
Deactivation Date:2021-03-30
Deactivation Code:
Reactivation Date:2021-06-30
Provider Licenses
StateLicense IDTaxonomies
FLPT31338225100000X
MI5501017407225100000X
COPTL.0017144225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist