Provider Demographics
NPI:1336538107
Name:YOUNTS, LUCAS (PTA)
Entity Type:Individual
Prefix:
First Name:LUCAS
Middle Name:
Last Name:YOUNTS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6933 CHARNEL LN
Mailing Address - Street 2:
Mailing Address - City:CLIMAX
Mailing Address - State:NC
Mailing Address - Zip Code:27233-9167
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:64 DANBURY RD STE 100
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:CT
Practice Address - Zip Code:06897-4438
Practice Address - Country:US
Practice Address - Phone:800-278-0332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-16
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10420225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant