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General NPI Number Information
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NPI Number | 1619345147
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Entity Type | Individual
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Provider Name | NICHOLAS LUCIUS PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 09/15/2015
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Last Update Date | 06/30/2021
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Provider Practice Location Address
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Address Line | 4731 S SANTA FE CIR
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City | ENGLEWOOD
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State | CO
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Zip | 80110-2200
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Country | US
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Telephone | 248-921-2282
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Fax |
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Provider Business Mailing Address
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Address Line | 4731 S SANTA FE CIR # 3-4
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City | ENGLEWOOD
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State | CO
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Zip | 80110-2200
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Country | US
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Telephone | 720-617-6151
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Fax | 720-617-6152
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT31338
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501017407
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PTL.0017144
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License Number State | CO
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