Healthcare Provider Details

I. General information

NPI: 1073158226
Provider Name (Legal Business Name): LUCAS MORGAN DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2019
Last Update Date: 11/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 KIANA COURT SUITE A
PADUCAH KY
42001-6787
US

IV. Provider business mailing address

100 KIANA COURT STE A
PADUCAH KY
42001-6787
US

V. Phone/Fax

Practice location:
  • Phone: 270-443-0681
  • Fax: 270-442-7948
Mailing address:
  • Phone: 270-443-0681
  • Fax: 270-442-7948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: