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General NPI Number Information
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NPI Number | 1598289274
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Entity Type | Individual
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Provider Name | LUCAS ALEXANDER BRYAN
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Gender | Male
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Dates
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Enumeration Date | 08/03/2017
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Last Update Date | 12/10/2025
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Provider Practice Location Address
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Address Line | 10189 N 4800 W
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City | HIGHLAND
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State | UT
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Zip | 84003-8828
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Country | US
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Telephone | 801-610-8810
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Fax |
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Provider Business Mailing Address
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Address Line | 642 E 60 S
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City | AMERICAN FORK
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State | UT
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Zip | 84003-2862
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Country | US
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Telephone | 208-529-3096
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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