Healthcare Provider Details

I. General information

NPI: 1114494713
Provider Name (Legal Business Name): DR. LUCAS BROHM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2018
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 ADAM SHEPHERD PKWY STE 1
SHEPHERDSVILLE KY
40165-6640
US

IV. Provider business mailing address

190 SHADOWMEADE LN
MT WASHINGTON KY
40047-6277
US

V. Phone/Fax

Practice location:
  • Phone: 502-921-0272
  • Fax: 502-921-0465
Mailing address:
  • Phone: 502-538-2332
  • Fax: 502-538-2514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number007544
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code2251E1300X
TaxonomyClinical Electrophysiology Physical Therapist
License Number007544
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: