Provider Demographics
NPI:1194317529
Name:LUCAS, RYAN PATRICK (DPT)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:PATRICK
Last Name:LUCAS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3230 MAPLE AVE APT 479
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-1347
Mailing Address - Country:US
Mailing Address - Phone:281-467-9579
Mailing Address - Fax:
Practice Address - Street 1:375 MUNICIPAL DR STE 108
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3543
Practice Address - Country:US
Practice Address - Phone:214-575-4040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1342138OtherLICENSE NUMBER