Provider Demographics
NPI:1124519913
Name:LAMMERT, LUCAS WILLIAM (ATC, LAT, NREMT)
Entity type:Individual
Prefix:
First Name:LUCAS
Middle Name:WILLIAM
Last Name:LAMMERT
Suffix:
Gender:M
Credentials:ATC, LAT, NREMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1195 35TH ST N APT 108
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-3174
Mailing Address - Country:US
Mailing Address - Phone:404-520-0801
Mailing Address - Fax:
Practice Address - Street 1:1300 17TH AVE N
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102
Practice Address - Country:US
Practice Address - Phone:231-701-6378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDBOC3469452255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer