Provider Demographics
NPI:1629316336
Name:FLICKINGER, LUCAS SAMUEL (DPT)
Entity Type:Individual
Prefix:DR
First Name:LUCAS
Middle Name:SAMUEL
Last Name:FLICKINGER
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 1:1560 BEAVER RUN RD
Mailing Address - Street 2:
Mailing Address - City:MIFFLINBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17844-6707
Mailing Address - Country:US
Mailing Address - Phone:570-527-6842
Mailing Address - Fax:
Practice Address - Street 1:1560 BEAVER RUN RD
Practice Address - Street 2:
Practice Address - City:MIFFLINBURG
Practice Address - State:PA
Practice Address - Zip Code:17844-6707
Practice Address - Country:US
Practice Address - Phone:570-527-6842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-30
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT020898225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist