Provider Demographics
NPI:1770826737
Name:LUCASSIAN, ADAM JOHN (ATC)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:JOHN
Last Name:LUCASSIAN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 WINDJAMMER PL
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33594-4474
Mailing Address - Country:US
Mailing Address - Phone:586-872-1811
Mailing Address - Fax:
Practice Address - Street 1:1408 WINDJAMMER PL
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33594-4474
Practice Address - Country:US
Practice Address - Phone:586-872-1811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-28
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA26312255A2300X
GAAT0035272255A2300X
FLAL64132255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer