Provider Demographics
NPI:1629706882
Name:WILLIAMS, LUCAS BENTON (DPT)
Entity Type:Individual
Prefix:
First Name:LUCAS
Middle Name:BENTON
Last Name:WILLIAMS
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 1:973 HIGHWAY 51 N
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38019-1594
Mailing Address - Country:US
Mailing Address - Phone:901-617-0100
Mailing Address - Fax:
Practice Address - Street 1:973 HIGHWAY 51 N
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:TN
Practice Address - Zip Code:38019-1594
Practice Address - Country:US
Practice Address - Phone:901-617-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN144322251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic