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General NPI Number Information
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NPI Number | 1407410772
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Entity Type | Individual
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Provider Name | LUCNY LOUIS
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Gender | Male
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Dates
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Enumeration Date | 04/23/2019
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 1729 LAKELAND HILLS BLVD
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City | LAKELAND
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State | FL
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Zip | 33805-3016
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Country | US
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Telephone | 863-940-2908
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Fax |
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Provider Business Mailing Address
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Address Line | 1729 LAKELAND HILLS BLVD
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City | LAKELAND
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State | FL
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Zip | 33805-3016
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Country | US
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Telephone | 863-940-2908
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA25948
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 9121051
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License Number State | FL
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