MEDICARE: LUCAS GROSS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1518899459
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUCAS GROSS

Provider Business Mailing Address
First Line	:	4139 LANSING AVE
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33026-4935
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	805 SE 3RD AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33316-1105
Country	:	US
Telephone Number	:	954-256-9052
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2026
Last Update Date	:	06/03/2026

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Directions to “ LUCAS GROSS ” Practice Location

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