Provider Demographics
NPI:1689117046
Name:WITMER, LUCAS (DPT)
Entity Type:Individual
Prefix:
First Name:LUCAS
Middle Name:
Last Name:WITMER
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 1:7 HANSON ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-4113
Mailing Address - Country:US
Mailing Address - Phone:603-605-6116
Mailing Address - Fax:603-343-2130
Practice Address - Street 1:13670 METROPOLIS AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4346
Practice Address - Country:US
Practice Address - Phone:239-561-0700
Practice Address - Fax:239-561-5643
Is Sole Proprietor?:No
Enumeration Date:2016-12-02
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 31740225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL68-6520OtherMEDICARE ID
FL68-6520OtherMEDICARE ID