Provider Demographics
NPI:1922403328
Name:BROWN, LUCAS (PT, DPT)
Entity Type:Individual
Prefix:
First Name:LUCAS
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20347 TIMBERLAKE ROAD SUITE B
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502
Mailing Address - Country:US
Mailing Address - Phone:434-845-9053
Mailing Address - Fax:434-528-2788
Practice Address - Street 1:1111 CORPORATE PARK DRIVE
Practice Address - Street 2:SUITE B
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551
Practice Address - Country:US
Practice Address - Phone:434-525-4851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305207434225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist