Provider Demographics
NPI:1649938978
Name:NOGUEIRA, LUCAS MOTTA (PT, DPT)
Entity type:Individual
Prefix:
First Name:LUCAS
Middle Name:MOTTA
Last Name:NOGUEIRA
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 1:128 FERRY ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07105-2115
Mailing Address - Country:US
Mailing Address - Phone:973-344-0012
Mailing Address - Fax:
Practice Address - Street 1:15 PEMBROKE LN
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08757-4420
Practice Address - Country:US
Practice Address - Phone:973-951-2144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-03
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02007100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist