Provider Demographics
NPI:1821334343
Name:LUCAS, MARK AUSTIN (PT)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:AUSTIN
Last Name:LUCAS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 SOMERSBY LN
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-1575
Mailing Address - Country:US
Mailing Address - Phone:980-307-0992
Mailing Address - Fax:
Practice Address - Street 1:205 CHAUCER LN
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-7027
Practice Address - Country:US
Practice Address - Phone:980-307-0992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-02
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP13278225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist