Provider Demographics
NPI:1255142725
Name:JOSHI, LUCAS JAG (PT, DPT)
Entity type:Individual
Prefix:
First Name:LUCAS
Middle Name:JAG
Last Name:JOSHI
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 1:80 LONG MEADOW HILL RD
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-1324
Mailing Address - Country:US
Mailing Address - Phone:203-794-2161
Mailing Address - Fax:
Practice Address - Street 1:80 LONG MEADOW HILL RD
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-1324
Practice Address - Country:US
Practice Address - Phone:203-794-2161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053796225100000X
CT14638225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist