Provider Demographics
NPI:1013323443
Name:CHRISTENSEN, LUCAS (PT)
Entity Type:Individual
Prefix:
First Name:LUCAS
Middle Name:
Last Name:CHRISTENSEN
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 1:4631 WHITMAN LN SE
Mailing Address - Street 2:STE D
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98513-2250
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:630-759-9510
Practice Address - Street 1:3048 E BASELINE RD
Practice Address - Street 2:SUITE 125
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-7286
Practice Address - Country:US
Practice Address - Phone:480-222-0655
Practice Address - Fax:480-222-1457
Is Sole Proprietor?:No
Enumeration Date:2014-07-07
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA225100000X
AZ10982225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ946863Medicaid
AZ946863Medicaid