MEDICARE: LUCAS JOHN VEITZEL

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	261QP2000X	Physical Therapy Clinic/Center	1399578	TX
2	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1851125678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUCAS JOHN VEITZEL

Provider Business Mailing Address
First Line	:	136 AMORY DR
Second Line	:
City	:	BENBROOK
State	:	TX
Zip	:	76126-3215
Country	:	US
Telephone Number	:	940-923-5165
Fax Number	:

Provider Business Practice Location Address
First Line	:	5520 SYCAMORE SCHOOL RD STE 230
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76123-3062
Country	:	US
Telephone Number	:	817-423-1621
Fax Number	:

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

Provider Enumeration Date	:	08/26/2024
Last Update Date	:	05/28/2025

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Directions to “ LUCAS JOHN VEITZEL ” Practice Location

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