Provider Demographics
NPI:1861484719
Name:SILVA, LUCAS ROGER (DPT)
Entity Type:Individual
Prefix:
First Name:LUCAS
Middle Name:ROGER
Last Name:SILVA
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 1:180 W NORWALK RD
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06850-4311
Mailing Address - Country:US
Mailing Address - Phone:203-299-1207
Mailing Address - Fax:
Practice Address - Street 1:45 GROVE ST
Practice Address - Street 2:
Practice Address - City:NEW CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06840-5330
Practice Address - Country:US
Practice Address - Phone:203-966-5752
Practice Address - Fax:203-966-7507
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT07011225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTANC1555OtherOXFORD
CT080007011CT04OtherANTHEM BC/BS