MEDICARE: LUCAS SEBASTIEN SANDS LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	104521	FL

General Provider Information

NPI Number	:	1619808235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUCAS SEBASTIEN SANDS LMT

Provider Business Mailing Address
First Line	:	3505 75TH ST N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33710-1253
Country	:	US
Telephone Number	:	970-819-9897
Fax Number	:

Provider Business Practice Location Address
First Line	:	1923 16TH ST N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33704-3919
Country	:	US
Telephone Number	:	727-306-2206
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2026
Last Update Date	:	05/25/2026

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