Provider Demographics
NPI:1962101477
Name:LUCAS, JOSHUA ROBERT (EP-C)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:ROBERT
Last Name:LUCAS
Suffix:
Gender:M
Credentials:EP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 S LEWIS ST
Mailing Address - Street 2:
Mailing Address - City:BELLFLOWER
Mailing Address - State:MO
Mailing Address - Zip Code:63333-2118
Mailing Address - Country:US
Mailing Address - Phone:314-497-3062
Mailing Address - Fax:
Practice Address - Street 1:709 S LEWIS ST
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:MO
Practice Address - Zip Code:63333-2118
Practice Address - Country:US
Practice Address - Phone:314-497-3062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-23
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1068300224Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist