Healthcare Provider Details

I. General information

NPI: 1588427306
Provider Name (Legal Business Name): LUCA PRADA PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2024
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

454 PASSAIC ST
HACKENSACK NJ
07601-1519
US

IV. Provider business mailing address

PO BOX 416495
BOSTON MA
02241-3602
US

V. Phone/Fax

Practice location:
  • Phone: 201-488-7905
  • Fax: 201-488-7901
Mailing address:
  • Phone: 914-294-4050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA02238800
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: