Provider Demographics
NPI:1740681154
Name:HALLIWELL, LUCAS R
Entity type:Individual
Prefix:MR
First Name:LUCAS
Middle Name:R
Last Name:HALLIWELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9892 SPEARHEAD DR
Mailing Address - Street 2:
Mailing Address - City:BRECKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44141-3153
Mailing Address - Country:US
Mailing Address - Phone:412-370-4278
Mailing Address - Fax:
Practice Address - Street 1:9892 SPEARHEAD DR
Practice Address - Street 2:
Practice Address - City:BRECKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44141-3153
Practice Address - Country:US
Practice Address - Phone:412-370-4278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-05
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH08053225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant