Provider Demographics
NPI:1851793145
Name:CARSON, LUCAS (MS, LAT, ATC, CPT)
Entity Type:Individual
Prefix:MR
First Name:LUCAS
Middle Name:
Last Name:CARSON
Suffix:
Gender:M
Credentials:MS, LAT, ATC, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 BEECH HAVEN RD
Mailing Address - Street 2:P.O. BOX 162
Mailing Address - City:BANNER ELK
Mailing Address - State:NC
Mailing Address - Zip Code:28604
Mailing Address - Country:US
Mailing Address - Phone:724-504-8804
Mailing Address - Fax:828-898-8742
Practice Address - Street 1:191 MAIN ST
Practice Address - Street 2:
Practice Address - City:BANNER ELK
Practice Address - State:NC
Practice Address - Zip Code:28604-0128
Practice Address - Country:US
Practice Address - Phone:828-898-8892
Practice Address - Fax:828-898-8742
Is Sole Proprietor?:No
Enumeration Date:2014-09-18
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22232255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer