Provider Demographics
NPI:1891738837
Name:LUCCA, THOMAS GEORGE (PT)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:GEORGE
Last Name:LUCCA
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 1:48 NEIL DR
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-1241
Mailing Address - Country:US
Mailing Address - Phone:631-786-7911
Mailing Address - Fax:
Practice Address - Street 1:48 NEIL DR
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-1241
Practice Address - Country:US
Practice Address - Phone:631-940-0878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018817-0225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ22F41Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER