Provider Demographics
NPI:1639896624
Name:MAZE, LUCKY (PT, DPT, OCS)
Entity type:Individual
Prefix:DR
First Name:LUCKY
Middle Name:
Last Name:MAZE
Suffix:
Gender:
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 BLOSSOM RUN
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174-4542
Mailing Address - Country:US
Mailing Address - Phone:615-913-6862
Mailing Address - Fax:
Practice Address - Street 1:5073 MAIN ST STE 140
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-2738
Practice Address - Country:US
Practice Address - Phone:615-861-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-20
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN163432251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic