Provider Demographics
NPI:1760804702
Name:SMITH, LUCAS CHARLES (PT, DPT, CSCS)
Entity Type:Individual
Prefix:DR
First Name:LUCAS
Middle Name:CHARLES
Last Name:SMITH
Suffix:
Gender:M
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304-1619
Mailing Address - Country:US
Mailing Address - Phone:330-379-5337
Mailing Address - Fax:330-379-9758
Practice Address - Street 1:3838 MASSILLON RD
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:OH
Practice Address - Zip Code:44685-7964
Practice Address - Country:US
Practice Address - Phone:330-899-5599
Practice Address - Fax:330-899-5511
Is Sole Proprietor?:No
Enumeration Date:2014-01-10
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-11930225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist