Provider Demographics
NPI:1336623990
Name:WILLERS, LUCAS
Entity type:Individual
Prefix:
First Name:LUCAS
Middle Name:
Last Name:WILLERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3616 S CUSHMAN AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98418-2633
Mailing Address - Country:US
Mailing Address - Phone:253-279-9630
Mailing Address - Fax:
Practice Address - Street 1:6220 S ALASKA ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98408-1317
Practice Address - Country:US
Practice Address - Phone:253-476-5300
Practice Address - Fax:253-476-5365
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60847864225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist