Healthcare Provider Details

I. General information

NPI: 1992624167
Provider Name (Legal Business Name): LUCAS ALLEN SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15251 S 50TH ST APT 2042
PHOENIX AZ
85044-9116
US

IV. Provider business mailing address

15251 S 50TH ST APT 2042
PHOENIX AZ
85044-9116
US

V. Phone/Fax

Practice location:
  • Phone: 480-529-7014
  • Fax:
Mailing address:
  • Phone: 480-529-7014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: