MEDICARE: MR. PATRICK FRANCIS LUCAS PTA, LAT, ATC, CSCS

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	2255A2300X	Athletic Trainer	AT1469	TX
2	225200000X	Physical Therapy Assistant	2124137	TX

General Provider Information

NPI Number	:	1780894493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PATRICK FRANCIS LUCAS PTA, LAT, ATC, CSCS

Provider Business Mailing Address
First Line	:	905 NADINE ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77009-2440
Country	:	US
Telephone Number	:	713-426-6297
Fax Number	:

Provider Business Practice Location Address
First Line	:	905 NADINE ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77009-2440
Country	:	US
Telephone Number	:	713-426-6297
Fax Number	:

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

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	09/25/2021

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